Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug 12:14:318-21.
doi: 10.12659/AJCR.883998. eCollection 2013.

Peripheral corneal ulceration associated with rheumatoid arthritis

Vasileios Karampatakis  1 , Vasileios Konidaris, Maria Michailidou, Antonios Gerofotis, Michail Daniilidis
Affiliations

Peripheral corneal ulceration associated with rheumatoid arthritis

Vasileios Karampatakis et al. Am J Case Rep. .

Abstract

Patient: Female, 60 FINAL DIAGNOSIS: Corneal ulceration Symptoms: Blurred vision Medication: Abatacept Clinical Procedure: - Specialty: Ophthalmology.

Objective: Management of emergency care.

Background: To report a case of a patient with rheumatoid arthritis (RA) and associated peripheral corneal ulceration.

Case report: A 60-year-old woman with RA diagnosed 15 years ago, under immunosuppressive therapy (IV abatacept 250 mg/month), demonstrated blurring of vision in her RE (right eye). Visual acuity was 6/10 in the RE and 10/10 in the LE. Slit lamp examination revealed a paracentral superior corneal melt in the RE. Anterior chamber reaction was 2+. Laboratory investigations revealed positive anti-Ro and anti-La, anti-Extractable Nuclear Antigens (anti-ENA, ELISA), while anti-Sm, anti-Rnp, anti-Jo1 and anti-Scl70 were found negative. IgG and IgA serum immunoglobulins were found elevated, but IgE and IgM were within normal levels. Further evaluation for the underlying disease revealed highly elevated rheumatoid factor and C-reactive protein. The patient, who had been receiving anti-TNF during the last 6 months, underwent treatment with topical tobramycin and lubricants and oral prednisone 60 mg/day with tapering doses, to which methotrexate p.os. 15 mg/week was added. The condition improved within a few days after the initiation of prednisone treatment. Re-epithelization occurred 1 week after the onset of the immunosuppressive treatment. Only punctate fluorescein dye uptake was detected in the margins of the lesion.

Conclusions: The effective control of the underlying disease and early diagnosis of the dry eye syndrome in RA patients may prevent serious corneal complications such as corneal ulceration. The initiation of treatment with steroids and immunosuppresants was found to halt the progression of keratolysis, and assisted re-epithelization.

Keywords: ant-TNF; anti-ENA; immunosuppressive therapy; keratolysis; peripheral ulceration; rheumatoid arthritis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Slit-lamp examination in the right eye showing a paracentral superior corneal melt.
See this image and copyright information in PMC

References

    1. Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis. Eur J Radiol. 1998;27:18–24. - PubMed
    1. Scutellari PN, Orzincolo C. Rheumatoid arthritis: sequences. Eur J Radiol. 1998;27:31–38. - PubMed
    1. Baldassano VF., Jr Ocular manifestations of rheumatic diseases. Curr Opin Ophthalmol. 1998;9:85–88. - PubMed
    1. Polanska V, Sery O, Fojtik Z, Hlinomazova Z. The presence of dry eye syndrome and corneal complications in patients with rheumatoid arthritis and its association with -174 gene polymorphism for interleukin 6. Cesk Slov Oftalmol. 2008;64:77–80. - PubMed
    1. Zlatanovic G, Veselinovic D, Cekic S, et al. Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci. 2010;10:323–27. - PMC - PubMed

LinkOut - more resources