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Study sheds new light on sight-threatening arthritis in children
Researchers at UCL, Moorfields Eye Hospital and Great Ormond Street Hospital (GOSH) have published a new study which challenges how an arthritis-associated eye disease has been previously understood.
The study - funded by us, Moorfields Eye Charity, Arthritis UK and Fight for Sight - could open the door to new treatments that help protect children’s sight.
Juvenile idiopathic arthritis (JIA) is the most common form of arthritis in children under the age of 16, affecting around one in every 1,000 children in the UK. Around a third of patients with JIA also develop uveitis – an inflammatory condition of the eye that is potentially sight-threatening.
Although some treatments are available today for the condition, many affected children still experience some degree of permanent vision loss by the time they reach adulthood.
A team from UCL, GOSH, and Moorfields Eye Hospital published a new study today in Nature Communications that provides a clearer picture of the immune cells involved in JIA-associated uveitis.
JIA-uveitis can be difficult to detect early, because it often causes no obvious symptoms.
“JIA-uveitis can be difficult to detect early, because in some patients, it can cause no obvious symptoms,” explains Dr Beth Jebson (Research Fellow at UCL), first author of the study.
The immune system is made up of a range of important cells which, together, protect the body against infections and toxins. Two of these are B cells and T cells, which each play distinct roles in the immune system.
JIA-uveitis occurs when cells like these malfunction and attack our own tissues in the eye, mistaking them for foreign invaders. This is what makes JIA-uveitis an autoimmune condition.
To date, T cells have been considered the main immune cells responsible for the condition. However, this new data suggests that B cells are also playing a role in the disease – presenting a new potential treatment strategy.
However, effectively studying the disease and understanding the immune responses that cause eye inflammation requires careful analysis of eye samples from children - samples that are difficult to obtain safely. This has affected how researchers have been able to study the disease, until now.
We examined rare samples taken directly from the eyes of children with uveitis.
Senior author of the study, Dr Lizzy Rosser (Associate Professor at UCL), explains, “Through immense collaborative effort with Great Ormond Street Hospital and Moorfields Eye Hospital, we examined rare samples taken directly from the eyes of children with uveitis, who were already undergoing surgery for related complications such as cataracts. We also were able to investigate carefully preserved historical eye samples.”
In this study, the team combined blood data with the rare eye samples to explore disease mechanisms more directly. They first compared blood samples from children with arthritis alone (JIA) and children with both arthritis and eye inflammation (JIA-uveitis).
“This allowed us to see which immune cells were present in the inflamed eye and compare this with what we saw in the blood,” adds Lizzy.
This work is a great example of the power of patient-driven research.
Through their analysis, the researchers found that B cells were consistently present in increased numbers in the blood and inflamed eyes of JIA-uveitis patients.
“Our findings challenge the idea that uveitis is driven by T cells alone and show that B cells may also be playing an important role,” says Beth.
Dr Ameenat Lola Solebo (Wellcome Trust Career Development Fellow and Consultant Paediatric Ophthalmologist at GOSH), another author of the study, comments, “This work is a great example of the power of patient-driven research. It uses samples from a new biobank (called ‘CHOIR’) which was inspired by and named by our patients.”
The findings mark a major shift in how uveitis is understood, shedding light on key mechanisms that lead to vision loss in children with the condition.
Lizzy states, “The pathway targeted in this study is already being explored in adults with autoimmune diseases. Following careful clinical trials, we hope that existing treatments could one day be adapted or tested for this sight-threatening condition.
“Our next steps are to understand if we can find similar pathways at play in children with eye disease who do not have arthritis, as this group is underrepresented in research studies.”
This research highlights the importance of medical research in improving outcomes for children with serious and potentially blinding eye diseases.
Angela Hind, Chief Executive at the Medical Research Foundation, comments, “For reasons we still don’t fully understand, children with arthritis can also develop uveitis, and for many the disease does not respond to current treatments, with devastating consequences for their sight and long-term health.
"This research has uncovered vital new insights into the immune responses driving eye inflammation, highlighting the importance of medical research in improving outcomes for children with serious and potentially blinding eye diseases. We hope these findings will lay the groundwork for future research and more effective treatments.”
Read the full study here >>
