Ocular manifestation of rheumatoid arthritis-different forms and frequency

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with a number of extra-articular organ manifestations. Ocular manifestations involved with RA are keratoconjunctivitis sicca, episcleritis, scleritis , corneal changes, and retinal vasculitus. The etiopathogenesis of this autoimmune disorder is still unknown. Aim of our study was to present different ocular manifestations of RA and their frequency. We have examined 691 patient with the diagnoses of RA. All examined patients were in I or II stage of the disease according to criteria of The American College of Rheumatology. Ophthalmological exam obtained: visual acuity by Snellen sings, biomicroscopy of anterior segment, Schirmer test, tear break-up time (BUT), applanation tonometry and indirect ophthalmoscopy. In all patients with retinal vasculitis fotofundus and in indicated cases fluorescein angiography was preformed. The most common manifestation of ocular involvement was keratoconjunctivitis sicca. Episcleritis was diagnosed in 5.06% patients with RA, while scleritis was present in 2.06% of patients. Diffuse scleritis was present in one patient, while nodular was present in 13 patients. There were no patients with posterior or necrotizing scleritis among examined patients. Sclerosing keratitis was diagnosed in 11 female patients. It is characterized with peripheral thickening and opacification of the stroma adjacent to the site of inflammation. Posterior scleritis or scleromalacia of cornea was not present in our patients, because all of them were in I or II stage of disease. Retinal vasculitis was present in three patients, two male and one female patient (0.45%). Ocular manifestation was present in 27.2% of patients. Women were more affected.

FIGURE 1

Keratoconjunctivitis sicca

FIGURE 2

Episcleritis

FIGURE 3

Sclerosing keratitis

FIGURE 4

FA of peripheral branch vein inflammation in patient with RA