Can Appropriate Systemic Treatment Help Protect the Cornea in Patients With Rheumatoid Arthritis? A Multidisciplinary Approach to Autoimmune Ocular Involvement

Abstract

Purpose:To correlate rheumatologic with ophthalmic and laboratory findings in patients with rheumatoid arthritis (RA) to identify what effect these have on development of ocular disease.Methods:This is a cross-sectional study of 172 eyes of 86 patients with RA. Patients were examined by a group of rheumatologists. Sociodemographic, clinical, and laboratory data were collected. All patients underwent complete ophthalmologic examination including corneal topography and endothelial cell count.Results:There was no significant correlation between RA-negative prognostic indicators (NPIs) and pathologic corneal findings. Patients using disease-modifying antirheumatic drugs (DMARDs) and antimalarial drugs had greater corneal volumes (mean difference 8.51 mm3, 90% confidence interval [CI], 3.98–13.04, P = 0.004; and 2.24, 90% CI, 0.32–4.54, P = 0.048, respectively). Patients using azathioprine had lower endothelial cell counts compared with those using other drugs (mean difference 180 cells/mm2, 90% CI, 69–291, P = 0.008). Patients using biologic DMARDs had better tear osmolarity values (between 280 and 300 mOsm/L) than patients not using them (mean difference 14.3 mOsm/L, P = 0.022). There was no correlation between NPIs of RA and positive keratoconus screening indices (Spearman correlation OD −0.013, P = 0.91; OS −0.033, P = 0.76).Conclusions:There was no clear correlation between RA-NPIs and pathologic corneal findings in our study. DMARDs treatment may help maintain corneal integrity in our patients and prevented collagenolytic manifestations of RA. Other medications such as azathioprine should be used carefully, as endothelial damage may potentially occur.

Safety of collagen cross linking in advanced keratoconus in a patient with scleroderma

“…It has been documented that DMARDs may help maintain corneal integrity and prevent collagenolytic manifestations in patients with autoimmune conditions like RA. 11 Ours' is the first case report mentioning the surgical intervention for keratoconus in a case of SSc. Mention of CXL in a patient with keratoconus in association with SSc, is made by SzucsG 12 et al, but to the best of our knowledge no detailed case report is available about CXL and its safety in patients with SSc.…”

“…It has been documented that DMARDs may help maintain corneal integrity and prevent collagenolytic manifestations in patients with autoimmune conditions like RA. 11…”

Corneal complications of rheumatoid arthritis

“…Authors believed that the chronic epitheliopathy and the corneal inflammation in patients with RA could be the cause for an increased risk for keratoconus [74]. This finding, however, was not supported by Amador-Patarroyo et al [57]. Moreover, authors showed that patients using DMARDs and antimalarial drugs had a higher corneal volume.…”

“…Moreover, authors showed that patients using DMARDs and antimalarial drugs had a higher corneal volume. Therefore, it is possible that those drugs could have a protective effect in the development of corneal disease by inhibiting the replication of leukocyte, the ocular surface inflammation and protecting against collagenolysis [57].…”

“…This finding, however, was not supported by Amador-Patarroyo et al . [57]. Moreover, authors showed that patients using DMARDs and antimalarial drugs had a higher corneal volume.…”