Prevalence and characteristics of eye involvement in patients with rheumatoid arthritis
Background and objective: Rheumatoid arthritis is a systemic inflammatory disease. Ocular manifestations involved with rheumatoid arthritis are keratoconjunctivitis sicca, episcleritis, scleritis, anterior and posterior uveitis, dry eyes and ulcerative keratitis. This study aimed to detect the prevalence of ocular manifestations in rheumatoid arthritis patients, find out the relation between the effects of disease modifying anti-rheumatic drugs, biological agents and ocular complications in rheumatoid arthritis patients and explore role of anti-cyclic citrullinated peptide antibodies.
Methods: This is a cross-sectional clinical study of 60 rheumatoid arthritis patients who have attended Rizgary Teaching Hospital in Erbil. A data information about symptoms of ocular manifestations and history of ocular complications before starting disease modifying anti-rheumatic drugs and/or biological agents were taken. Musculoskeletal examination, serum Anti-CCP antibodies test were done. Ocular examination by ophthalmologist was done.
Results: This study was conducted from April to November 2015 and involved 60 patients; 55 females and five males with a mean± SD age of 46 ± 11.46 years. Thirty nine (65%) patients had ocular manifestations of rheumatoid arthritis. The most frequent manifestation was dry eyes 30 (50.0%). There was no relation between severity of the rheumatoid arthritis disease and ocular manifestation (P = 0.529). There was a relationship between the Anti-CCP antibodies titer and presence of ocular manifestations in rheumatoid arthritis patients (P = 0.006). There were no curable effects of the disease modifying anti-rheumatic drugs, biological agents on ocular manifestations in rheumatoid arthritis patients (P = 0.787).
Conclusion: Dry eye was the most common ocular manifestation, anti-CCP antibodies are a sensitive marker for ocular manifestations. Disease modifying anti-rheumatic drugs and biological therapies provide no significant efficacy in treatment or prevent the occurrence of ocular manifestations in rheumatoid arthritis patients.
Macgregor AJ, Snieder H, Rigby AS, Koskenvuo M, Kaprio J, Silman AJ. Characterizing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis Rheum 2000; 43:30-7.
Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kërliu S, Rexhepi M. Extraarticular manifestation of seronegative and seropositive reumathoid arthritis Bosn. J Basic Med Sci 2010;10(1):27-31.
Lilleby V, Gran JT. Systemic rheumatoid arthritis: Tidsskr Nor Laegeforen2007; 117(29):4223-5.
Cimmino MA, Salvarani C, Macchioni P. Extra-articular manifestations in YZ Italian patients with rheumatoid arthritis. Rheumatol Int 2000; 19(6):213-7.
Kanski JJ. The eye in systemic disease. London: Butterworts; 2004.
Whitson WE, Krachmer JH. Adult rheumatoid arthritis. In: Gold DH, Weingeist TA, editors. The eye in systemic disease. Philadelphia: JB. Lippincott; 2003. P. 127-208.
Hakin KN, Ham J, Lightman SL. Use of orbital floor steroids in the management of patients with uniocular non-necrotizing scleritis. Ophthaloml 2005; 75(6):337-9.
Galor A, Jabs DA, Leder HA, Kedhar SR, Dunn JP, Peters GB. Comparison of antimetabolite drugs as corticosteroid-sparing therapy for non-infectious ocular inflammation. Ophthalmol 2008; 115(10):1826-32.
Nicki R, Colledge Brian R, Walker Stuart H, Ralston. Davidson`s principle and practise of medicine. 21 st edition. In: Doherty M,Ralston S.H, editors. Musculoskeletal disease. Edinburg: Academic press; 2010. p. 1090.
John H, Leslie J, Patience H. Primer on rheumatic disease. 13th ed. In : Frank B, Gerd R.B, editors .Glucocorticoids. Boston: MA, USA; 2013. p. 648.
Itty S, Pulido JS, Bakri SJ, Baratz KH, Matteson EL, Hodge DO. Anti-Cyclic Citrullinated Peptide, Rheumatoid Factor, and Ocular Symptoms Typical of Rheumatoid Arthritis. Trans Am Ophthalmol Soc 2008; 106:75–81.
El-Banna H, Jiman-Fatani A. Anti-cyclic citrullinated peptide antibodies and paraoxonase -1 polymorphism in rheumatoid arthritis. BMCMusculoskelet Disord 2014; 15: 379.
Zoto1 A, Selimi B. Ocular Involvement in Patients with Rheumatoid Arthritis. Ophthalmol Research J 2015; 4(4):99-103.
Zlatanovic G, Selionvic D, Cekic S, Zivkovic M, Jocic J, Zlatanovic M. Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosnian Journal of Basic Medical Science 2010; 10 (4): 323-7.
Charanya C. Ocular Manifestation in Rheumatoid Arthritis Patients Presenting to Tertiary Care Hospital in South India. International Journal of Scientific Study 2015.(3)8.
Zakeri Z, Parsa M, Zanjani H, Ansarimoghaddam A, Sandoughi M, Aminifard M, et al. Relationship Between Severity of RA and Dry Eye. Health Scope 2012; 1(4):186-8.
Gilboe IM, Kvien TK, Uhlig T, Husby G. Sicca symptoms and secondary Sjögren's syndrome in systemic lupus erythematosus: comparison with rheumatoid arthritis and correlation with disease variables. Rheum Disease 2001; 60(12):1103-9.
Paul A, Vignesh P, Srinivasan R. Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies. Clin Ophthalmol 2015; 9: 393–7.
Sobrin L, Kim EC, Christen W, Papadaki T, Letko E, Foster CS. Infliximab therapy for the treatment of refractory ocular inflammatory disease. Arch Ophthalmol 2007; 125(7):895-900.
Sobrin L, Christen W, Foster CS. Mycophenolate mofetil after methotrexate failure or intolerance in the treatment of scleritis and uveitis. Ophthalmol 2008; 115(8):1416-21.
Papaliodis GN, Chu D, Foster CS. Treatment of ocular inflammatory disorders with daclizumab. Ophthalmology 2003; 110(4):786-9
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