Predictors of One-Year Disease Inactivity in Pediatric Uveitis: A 25-Year Single-Center Retrospective Study from Tunisia

<title>Abstract</title> <p> <bold>Background</bold> Pediatric uveitis is an uncommon but potentially sight-threatening inflammatory disease. Its chronic and often silent course may delay diagnosis and increase the risk of ocular complications. Identifying predictors of early disease control could help improve risk stratification and therapeutic decision-making. <bold>Methods</bold> We conducted a single-center retrospective study in the Department of Pediatrics D, Béchir Hamza Children’s Hospital, Tunis, Tunisia, over a 25-year period from January 2000 to December 2024. Children aged &lt; 18 years with ophthalmologist-confirmed uveitis and at least 12 months of follow-up were included. Epidemiological, clinical, laboratory, imaging, etiological, therapeutic, and outcome data were collected. The primary outcome was disease inactivity at one year, defined according to Standardization of Uveitis Nomenclature criteria. Factors associated with one-year inactivity were analyzed using univariate analysis and multivariable logistic regression. <bold>Results</bold> Fifty-five children were included in the descriptive analysis, and 47 had complete one-year follow-up data. The mean age at diagnosis was 8.0 ± 3.6 years, and the male-to-female ratio was 0.9. Bilateral uveitis was observed in 74.5% of patients. Anterior uveitis and panuveitis were the predominant anatomical forms, each accounting for 43.6% of cases. Idiopathic uveitis was the leading etiology (61.8%), followed by juvenile idiopathic arthritis-associated uveitis (18.2%). Topical corticosteroids, systemic corticosteroids, and conventional immunosuppressive therapy were used in 83.6%, 72.7%, and 69.1% of patients. Disease inactivity at one year was achieved in 76.6% of patients, whereas relapses and ocular complications occurred in 44.7% and 36.2%, respectively. In multivariable analysis, positive antinuclear antibodies (odds ratio [OR] 17.33, 95% confidence interval [CI] 1.94–154.64; p = 0.011), immunosuppressive therapy (OR 5.54, 95% CI 1.18–26.07; p = 0.030), and absence of vitreous abnormalities (OR 11.73, 95% CI 1.33–103.80; p = 0.027) were independently associated with one-year disease inactivity. <bold>Conclusions</bold> In this Tunisian pediatric cohort, uveitis was predominantly idiopathic, frequently bilateral, and often chronic. Most children achieved disease inactivity at one year, although relapses and ocular complications remained common. Antinuclear antibody positivity, immunosuppressive therapy, and absence of vitreous abnormalities may help identify children more likely to achieve early inflammatory control. Prospective multicenter studies are needed to validate these findings and optimize risk-adapted management strategies. </p>