2The eye and inflammatory rheumatic diseases: The eye and rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis
Section snippets
Ocular complications of rheumatoid arthritis
The ocular complications of rheumatoid arthritis (RA) more commonly affect the front (anterior segment) than the back of the eye (posterior segment) [1]. Anterior segment disease includes dry eye, peripheral ulcerative keratitis (PUK), episcleritis and anterior scleritis [2]. Posterior segment disease includes posterior scleritis and rarely a retinal vasculitis [3].
What is the most frequent ocular manifestation of RA?
The most frequent ocular manifestation in patients with RA is dry eye disease (DED, keratoconjunctivitis sicca) with up to 45% of
What is the most common ophthalmic manifestation of AS?
The most common ophthalmic manifestation is acute anterior uveitis (AAU) that occurs in 40% of patients with AS with males more commonly affected than females, occurring typically in young adults between the ages of 20 and 40 years [44], [45]. It is estimated that up to one-third of patients with AAU have AS [46], and that 50% of patients presenting with AAU in the Western world are likely to be HLA-B27 positive [47].
Uveitis comprises a diverse group of conditions involving inflammation of the
What is the most common ophthalmic manifestation of PsA?
Ophthalmic manifestations are estimated to occur in 10% of patients with psoriasis [71], and 31% of patients with PsA [72], with the most common manifestation of PsA being uveitis, but seen at a lesser frequency (7%) than in AS [73]. Egeberg et al. performed a nationwide cohort study of the Danish population from 1 January 1997 through 31 December 2011 and included 74,129 Danish patients with psoriasis who were 18 years or older. They identified 74,129 cases of psoriasis and PsA and 13,114
Summary
RA, AS and PsA all have sight-threatening ocular complications. In RA, DED is the most common ocular manifestation with significant impact on the patient's life. Treatment options largely depend on patient preference. PUK is relatively rare but can lead to globe perforation. Underlying corneal infection must be excluded and urgent reconstructive surgery may be required. Systemic immunomodulation similar to scleritis is necessary. Scleritis causes an intense red eye with excruciating pain and
Conflict of interest/financial disclosure
Neither author has any conflict of interest nor any financial support, personal financial interest or commercial relationship relevant to the subject matter of this manuscript.
References (78)
- et al.
Ocular inflammatory diseases associated with rheumatoid arthritis
Nat Rev Rheumatol
(2014) - et al.
Scleritis: challenges in immunopathogenesis and treatment
Discov Med
(2013) - et al.
Retinal vasculitis in rheumatoid arthritis: an angiographic study
Clin Exp Rheumatol
(1990) - et al.
Secondary Sjögren's syndrome in rheumatoid arthritis
J Rheumatol
(1987) The definition and classification of dry eye disease: report of the definition and classification subcommittee of the international dry eye WorkShop
Ocul Surf
(2007)- et al.
Report of the TFOS/ARVO Symposium on global treatments for dry eye disease: an unmet need
Ocul Surf
(2012) - et al.
Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review
Ocul Surf
(2016) - et al.
Utility assessment to measure the impact of dry eye disease
Ocul Surf
(2006) - et al.
Utility assessment among patients with dry eye disease
Ophthalmology
(2003) - et al.
The association between dry eye disease and depression and anxiety in a large population-based study
Am J Ophthalmol
(2015)
Depression and anxiety in dry eye disease: a systematic review and meta-analysis
Eye
Management and therapy of dry eye disease: report of the management and therapy subcommittee of the international dry eye WorkShop
Ocul Surf
Corneal pain without stain: is it real?
Ocul Surf
A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's syndrome International Registry
Am J Ophthalmol
The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction
Invest Ophthalmol Vis Sci
Toxicity of natural tear substitutes in a fully defined culture model of human corneal epithelial cells
Invest Ophthalmol Vis Sci
Carboxymethylcellulose binds to human corneal epithelial cells and is a modulator of corneal epithelial wound healing
Invest Ophthalmol Vis Sci
Effects of punctal occlusion on clinical signs and symptoms and on tear cytokine levels in patients with dry eye
Ocul Surf
Conjunctival epithelium improvement after systemic pilocarpine in patients with Sjögren's syndrome
Br J Ophthalmol
Treatment of dry eye by autologous serum application in Sjogren's syndrome
Br J Ophthalmol
Incidence of corneal melting in association with systemic disease in the Yorkshire Region, 1995–7
Br J Ophthalmol
The eye: a window of opportunity in rheumatoid arthritis?
Nat Rev Rheumatol
Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies
Clin Ophthalmol
Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis
Ophthalmology
Peripheral ulcerative keratitis and corneal melt: a 10-year single center review with historical comparison
Cornea
Rheumatoid keratolysis: a series of 40 eyes
Eur J Ophthalmol
Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease
Br J Ophthalmol
Scleritis Ocul Immunol Inflamm
Evaluation of patients with scleritis for systemic disease
Ophthalmology
Rheumatic disease and scleritis
Ophthalmology
Scleritis and peripheral ulcerative keratitis
Rheum Dis Clin North Am
Scleritis and episcleritis
Br J Ophthalmol
Posterior scleritis: analysis of epidemiology, clinical factors, and risk of recurrence in a cohort of 114 patients
Ocul Immunol Inflamm
Flurbiprofen: a nonselective cyclooxygenase (COX) inhibitor for treatment of noninfectious, non-necrotizing anterior scleritis
Ocul Immunol Inflamm
Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis
Ophthalmology
Mycophenolate mofetil for the treatment of scleritis
Ophthalmology
Infliximab for the treatment of active scleritis
Can J Ophthalmol
Rituximab therapy for refractory scleritis: results of a phase I/II dose-ranging, randomized, clinical trial
Ophthalmology
Scleritis: immunopathogenesis and molecular basis for therapy
Prog Retin Eye Res
Cited by (45)
Standard for treatment of visceral involvement in rheumatoid arthritis
2021, Medicine (Spain)Rheumatoid arthritis
2021, Medicine (Spain)Biologic therapy in severe and refractory peripheral ulcerative keratitis (PUK). Multicenter study of 34 patients
2020, Seminars in Arthritis and RheumatismCitation Excerpt :Initial triggers of inflammatory response have been reported in some patients with PUK. The most common are surgery and activity of a systemic underlying disease [28,29]. They were searched in our patients.
Factors Predictive of Remission of Chronic Anterior Uveitis
2020, OphthalmologyCitation Excerpt :Also several other reports found that juvenile idiopathic uveitis was often accompanied by persistent disease.18–21 The diseases included in spondyloarthropathy—ankylosing spondylitis, psoriatic arthritis, and reactive arthritis—are also commonly known to be recurrent or chronic.22,23 It is interesting to note that HLA-B27 status was not associated with the incidence of remission, although HLA-B27 itself is associated with ankylosing spondylitis and psoriatic arthritis.