Ocular Manifestations in Rheumatoid Arthritis
Diamantis AlmaliotisMarina ZakalkaA. GerofotisKleopas ChatzicharalampousMaria EfstathiouMichael DaniilidisVasileios Karampatakis
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Abstract:
Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of this autoimmune disease vary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Their appearance, as well as their severity are related to RA chronicity and resistance to therapy. The treatment consists of corticosteroids, NSAIDs and cytotoxic drugs, depending on the type of ocular manifestations and the patient’s response to treatment.Keywords:
KERATOCONJUNCTIVITIS SICCA
Episcleritis
Keratoconjunctivitis
KERATOCONJUNCTIVITIS SICCA
Episcleritis
Rheumatism
Keratoconjunctivitis
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Purpose of review This article summarizes the pathophysiology of rheumatoid arthritis and common ocular manifestations that it is associated with: keratoconjunctivitis sicca, episcleritis, scleritis, and peripheral ulcerative keratitis. Recent findings Newer biologic agents are being used to effectively treat rheumatoid arthritis and its ocular manifestations. Summary The eye is a frequent extra-articular site of inflammation in patients with rheumatoid arthritis. Ocular involvement can range from more benign conditions such as keratoconjunctivitis sicca and episcleritis, to potentially vision and globe-threatening diseases like scleritis and peripheral ulcerative keratitis. Clinicians should be aware of these ophthalmic manifestations and the various treatment options that are available. Coordination between ophthalmology and rheumatology is helpful in the treatment of these patients.
Episcleritis
KERATOCONJUNCTIVITIS SICCA
Keratoconjunctivitis
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Purpose : To evaluate the clinical features of the patients with episcleritis and scleritis. Methods : Retrospective chart review was performed for above patients that had been followed from 1986. 8. 8 to 2001. 6. 4. Results : The number of patients with episcleritis was 17 (49%) and that of scleritis was 18 (51%). Ocular complication occurred in 59% of patients with episcleritis and 72% of patients with scleritis. Keratitis was the most common ocular complication. No patient with episcleritis had a decrease in visual acuity, whereas 33% of patients with scleritis did. Systemic diseases were found in 69% of episcleritis whereas 77% of patients with scleritis associated with systemic diseases. Rheumatoid arthritis was the most common one in both groups of patients. Conclusions : Ocular complications, systemic diseases, and decrease in visual acuity are associated more of commonly with scleritis than episcleritis. When scleritis is suspected, careful examinations for associated ocular complications should be performed and be followed with history taking and evaluation for associated systemic disease.
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THE VALUE of cortisone in the treatment of various diseases of the eye has been reported by numerous investigators.1Reports from Merck & Company claim beneficial results in phlyctenular conjunctivitis, keratitis, iritis, iridocyclitis, uveitis and sympathetic ophthalmia.2Beneficial effects may result when the drug is administered intramuscularly, by instillation of a saline suspension or by subconjunctival injection; and it is expected that the oral route will prove efficacious. The first two modes of therapy were used in the present case. The commonest ocular affections seen in conjunction with disease of joints (especially rheumatoid arthritis) are keratoconjunctivitis sicca (Sjögren's syndrome), episcleritis, primary uveal disease, scleritis and conjunctivitis.3Various authors have reported rheumatic granulomas of the sclera, external ocular muscles, orbital tissue and uveal tract.4Nodular formations of other causes are described.5Episcleral nodular tuberculosis may grossly resemble rheumatoid granulomas.6Except for the case described by
KERATOCONJUNCTIVITIS SICCA
Episcleritis
Sclera
Sympathetic ophthalmia
Uvea
Keratoconjunctivitis
Rheumatoid nodule
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Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-articular organ manifestations. Eye involvement is a frequent finding in patients with RA. Ocular conditions that occur because of RA are keratoconjunctivitis sicca (KCS), episcleritis, scleritis, corneal pathology and retinal vasculitis (Table I). Optic nerve involvement in the form of neuritis or ischaemic neuropathy has been reported and tenosynovitis of the superior oblique muscle sheath (Brown's syndrome) is also an occasional manifestation. It should be borne in mind that the eye may also be affected by the treatment of RA with drugs such as chloroquine, which can cause loss of vision as a result of maculopathy.
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Optic neuritis
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Ophthalmic complications in RA:
Episcleritis
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Secondary glaucoma
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Episcleritis
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Episcleritis
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Optic neuritis
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Episcleritis and scleritis are two common inflammatory disorders encountered by primary care practitioners. Although episcleritis is a self-limited disease that usually resolves within 2 to 3 weeks, severe symptoms may require the use of topical steroids or, in recalcitrant cases, nonsteroidal anti-inflammatory agents (NSAIAs). Scleritis is a painful, generalized inflammation of the eye that is often associated with systemic disease. The necrotizing form of scleritis is the most serious, requiring aggressive treatment with NSAIAs and systemic steroids. Significant sequelae of scleritis include uveitis, glaucoma, cataract, and retinal detachment.
Episcleritis
Retinal Disorder
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