J.ophthalmol.(Ukraine).2022;5:12-18.
http://doi.org/10.31288/oftalmolzh202251218
Received: 03.08.2022; Accepted: 22.08.2022; Published on-line: 27.10.2022
Clinical manifestations of keratitis and corneal ulcers in patients with rheumatoid arthritis: a retrospective analysis
L. Y. Riazanova, G. I. Drozhzhyna
SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"; Odesa (Ukraine)
TO CITE THIS ARTICLE: Riazanova LY, Drozhzhyna GI. Clinical manifestations of keratitis and corneal ulcers in patients with rheumatoid arthritis: a retrospective analysis. J.ophthalmol.(Ukraine).2022;5:12-8. http://doi.org/10.31288/oftalmolzh202251218
Background: The prevalence of keratitis and corneal ulcers among rheumatoid arthritis (RA) patients with corneal disease is not known for certain, and the features of their clinical manifestations have been not sufficiently studied.
Purpose: To retrospectively assess the prevalence and clinical manifestations of keratitis and corneal ulcers in RA patients with corneal disease based on the medical records of patients that were hospitalized at Corneal Pathology Department of the Filatov Institute from January, 2014, through August, 2019.
Material and Methods: We have retrospectively examined the medical records of 6627 patients that were hospitalized at Corneal Pathology Department of the institute in the above period of time.
Results: Of the 6627 patients that were hospitalized, 82 (or 1.2%) were RA patients with keratitis and/or corneal ulcers. Of these 82 patients aged 37 to 79 years, 23 (28%) were men and 59 (72%) were women. Bilateral corneal lesions were found in 71 (86.6%), and unilateral corneal lesions, in 11 (13.4%) of the 82 study patients, with 153 eyes totally included in the study. Punctate or filamentary keratitis was found in 90 (58.8%) eyes. Severe corneal lesions (ulcers or keratoscleromalacia) were found in 63 (41.2%) eyes. Of the 82 RA patients with corneal lesions of the current study, 39 (47.6%) did not receive basic therapy for RA, and exhibited the most severe corneal lesions.
Conclusion: Patients with RA need to be systematically seen by an ophthalmologist and a rheumatologist. The absence of treatment with basic therapy for RA can cause ocular complications. A patient with RA needs to be treated for any corneal lesion at a tertiary care center where a required surgical procedure can be timely performed. The success of treatment for corneal lesions in a RA patient requires a set of treatment measures, and adequate basic therapy for RA is a necessary component of this set.
Keywords: keratitis, corneal ulcer, keratoscleromalacia, rheumatoid arthritis
References
1.Kovalenko VM, Kornatskyi VM, editors. [Demographic and health state characteristics of Ukrainian people: an analytical and statistical manual]. Kyiv; 2010. Ukrainian.
2.Majitha V, Geraci SA. Rheumatoid arthritis: diagnosis and management. Am J Med. 2007 Nov;120(11):936-9.
3.Mazurov VI, Trofimov EA. [Innovative methods of treatment of autoimmune disorders]. Vestnik Rossiiskoi akademii meditsinskikh nauk. 2015;2:165-8. Russian.
4.Iaremenko OB, Mykytenko AM. [Early diagnosis of rheumatoid arthritis]. Zdorov’ia Ukrainy. 2008;5(1):63-5. Ukrainian.
5.Kovalenko VM, Bortkevych OP, Biliavska IuV. [Current aspects of the diagnosis of rheumatoid arthritis]. Zdorov’ia Ukrainy. 2010;1:74-7. Ukrainian.
6.Neiko IeM, Iatsyshin RI, Shefiuk OV. [Rheumatoid arthritis: a current view on the problem]. Ukrainskyi revmatologichnyi zhurnal. 2009;2(36):35–9. Ukrainian.
7.Levitt A, McManus K, McClellan A, et al. Ocular inflammation in the setting of concomitant systemic autoimmune conditions in an older male population. Cornea. 2015;34:762–7.
8.Bettero RG, Cebrian RF, Skare TL. [Prevalence of ocular manifestation in 198 patients with rheumatoid arthritis: a retrospective study]. Arq Bras Oftalmol. 2008 May-Jun;71(3):365-9. Portuguese.
9.Daguano CR, Bochnia CR, Gehlen M. [Anterior uveitis in the absence of scleritis in a patient with rheumatoid arthritis: case report]. Arq Bras Oftalmol. 2011;74(2):132–3. Portuguese.
10.Hennessy AL, Katz J, Covert D, et al. A video study of drop instillation in both glaucoma and retina patients with visual impairment. Am J Ophthalmol. 2011 Dec;152(6):982-8.
11.Syniachenko OV. [Rheumatoid arthritis and ophthalmopathy]. Ukrainskyi revmatologichnyi zhurnal. 2012;50(4):1–5. Russian.
12.Katargina LA, Khvatova AV, Denisova EV. [The effectiveness of trabeculectomy with the use of cytotoxic drugs in the treatment of uveal glaucoma]. Oftalmokhirurgiia. 2002;3:37–40. Russian.
13.Rudakova AV. [Pharmacoeconomic aspects of treatment with the inhibitors of tumor necrosis factor of the chronic uveitis refractory to the basic therapy (including an associated with juvenile idiopathic arthritis)]. Pediatricheskaia farmakologiia. 2011;8(4):55–8. Russian.
14.Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Extra-articular manifestation of seronegative and seropositive rheumathoid arthritis. Bosn J Basic Med Sci. 2010 Feb; 10(1): 26–31.
15.Lilleby V, Gran JT. [Systemic rheumatoid arthritis]. Tidsskr Nor Laegeforen. 1997 Nov 30;117(29):4223-5. Norwegian.
16.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.
17.Sainz de la Maza M, Foster CS, Jabbur NS. Scleritis associated with rheumatoid arthritis and with other systemic immune-mediated diseases. Ophthalmology. 1994 Jul;101(7):1281-6; discussion 1287-8..
18.Fong LP, Sainz de la Maza M, Rice BA, Kupferman AE, Foster CS. Immunopathology of scleritis. Ophthalmology. 1991 Apr;98(4):472-9.
19.Felson DT, Anderson JJ, Boers M, et al. American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995;38:727–735.
20.Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62:722–727.
21.Cimmino MA, Salvarani C, Macchioni P, et al. Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatol Int. 2000;19(6):213–217.
22.Zlatanović G, Veselinović D, Cekić S, Zivković M, Dorđević-Jocić J, Zlatanović M. Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci. 2010;10(4):323-327.
23.Kovalenko VM, Shuba MM, Sholokhova LB. [Rheumatoid arthritis. Diagnosis and treatment]. Morion; 2001. Ukrainian.
24.Tarasova LN, Kudriashova IuI. [Clinical picture of pure corneal ulcers of different localizations]. Vestn Oftalmol. 1999 Jan-Feb;115(1):29-31. Russian.
25.Gregory JK, Foster CS. Peripheral ulcerative keratitis in the collagen vascular diseases. Int Ophthalmol Clin. 1996 Winter;36 (1): 21-30.
26.Smith VA, Hoh HB. Role of ocular matrix metalloproteinases in Peripheral Ulcerative Keratitis. Br J Ophthalmol. 1999 Dec; 83: 1376-1383.
27.Messmer EM, Foster CS. Vasculitic peripheral ulcerative keratitis. Surv Ophthalmol. 1999; 43 (5): 379-96.
28.Drozdova EA, Timoshevskaia EI. [Differential diagnosis and tactics of treatment of peripheral corneal lesions]. Tochka zrenia. Vostok-Zapad. 2017;1:57–60. Russian.
29.Solomon A, Meller D, Prabhasawat P, et al. Amniotic membrane grafts for nontraumatic corneal perforations, descemetoceles, and deep ulcers. Ophthalmology. 2002 Apr;109(4):694-703.
30.Singh G, Salvador VB, Bagchi A, Tushabe R, Abrudescu A. Rheumatoid arthritis-associated corneal ulceration with superimposed infection by methicillin-resistant Staphylococcus aureus: a complicated type of corneal melt. Am J Case Rep. 2014 Nov 27;15:523-5.
31.Ide T, Matsuda H, Nishida K, et al. Rheumatoid arthritis-associated corneal ulceration complicated by bacterial infection. Mod Rheumatol. 2005;15:454–58.
32.Squirell DM, Winfield J, Amos RS. Peripheral ulcerative keratitis corneal melt and rheumatoid arthritis: a case series. Rheumatology (Oxford). 1999;38(12):1245–48.
33.Perez VL, Azar DT, Foster CS. Sterile corneal melting and necrotizing scleritis after cataract surgery in patients with rheumatoid arthritis and collagen vascular disease. Semin Ophthalmol. 2002;17(3–4):124–30.
34.Itty S, Pulido JS, Bakri SJ, et al. Anti-cyclic citrullinated peptide, rheumatoid factor, and ocular symptoms typical of Rheumatoid arthritis. Trans Am Ophthalmol Soc. 2008;106:75–83.
35.Stepanov VK, Muriieva IV, Isaieva OV. [Curative keratoplasty in destructive corneal disease in patients with rheumatoid arthritis]. Vestnik OGU. 2015;12(187):231-3. Russian.
36.Kemeny-Beke A, Szodoray P. Ocular manifestations of rheumatic diseases. Int Ophthalmol. 2020 Feb;40(2):503-510.
37.Turk MA, Hayworth JL, Nevskaya T, Pope JE. Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis. J Rheumatol. 2021 Jan 1;48(1):25-34.
Disclosures
Corresponding Author: Riazanova LY, e-mail: lili.r@ukr.net
Athour Contribution: Riazanova L Y: Conceptualization; Data Curation; Formal Analysis; Writing – original draft; Writing – review & editing. Drozhzhyna GI: Conceptualization; Formal Analysis; Project administration;Writing – review & editing. All authors approved the final version of the manuscript and were responsible for submitting it for publication.
Disclaimer: The opinions presented in this article are those of the authors and do not necessarily represent those of their institutions.
Funding sources: No funding received
The study is a portion of Features of the Pathogenesis of Corneal Degenerative (Keratoconus), Inflammatory (Bacterial and Fungal Keratitis) and Autoimmune (Rheumatoid Arthritis, Stevens-Johnson Syndrome and Lyell's Syndrome) Disorders and Developing Novel Methods for Treating Them, a research program (Ukrainian State Registration No. 0119U103094).
Conflict of interest: The authors state that they have no conflict of interest that might bias this work.
Subjects: The study involved human subjects, was approved by the Ethics Committee, and adhered to the tenets of the Declaration of Helsinki. Informed consent was not obtained due to the retrospective nature of the study.
Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IOP, intraocular pressure; RA, rheumatoid arthritis; WHO, World Health Organization