The Association between Systemic Glucocorticoid Use and the Risk of Cataract and Glaucoma in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

ObjectiveGlucocorticoids (GCs) are often used to treat Rheumatoid Arthritis (RA) despite their many side effects and the availability of other effective therapies. Cataract and glaucoma are known side effects of GCs but the risk of them developing in the setting of GC use for RA is unknown. The aim was to perform a systematic review and meta-analysis to determine the association between GCs and the risk of developing cataract and/or glaucoma in RA.MethodsA systematic search was carried out using MEDLINE, EMBASE, and Web of Science. All RCTs comparing GC use to non-use in RA populations were sought. Observational studies reporting cataract and/or glaucoma amongst GC users and non-users were also included. Data extracted included incidence/prevalence of cataract and/or glaucoma in each arm, dose and duration of therapy. Two independent reviewers performed quality assessment.Results28 RCTs met eligibility criteria, however only 3 reported cataracts and glaucoma, suggesting significant under-reporting. An association between GC use and the development of cataracts in RA patients was seen in observational studies but not RCTs. There was no statistically significant association between GC use and the development of glaucoma, although data were sparse. There were insufficient data to determine the impact of dose and duration of therapy.ConclusionThe current literature suggests a possible association between GC use and the development of cataract. However, this risk cannot be accurately quantified in RA from the available evidence. RCTs have not adequately captured these outcomes and well-designed observational research is required.

Induced Torpor as a Countermeasure for Low Dose Radiation Exposure in a Zebrafish Model

“…Given that our results represent a cell state 48 h after the last radiation exposure this suggests a prolonged stress response and is strengthened by the evidence showing that radiation produces a persistent stress response in space radiation studies of mouse intestine [ 135 ]. Sustained systemic GC levels have been implicated in pathologies such as osteoporosis, myopathy, reduced serum vitamin D levels and cataracts [ 136 , 137 ] which are already known to occur in spaceflight [ 138 , 139 , 140 ]. This points to a role for radiation-induced GC levels being a contributing factor.…”

Cataract Surgery with Intraocular Lens Implantation in Juvenile Idiopathic Arthritis-Associated Uveitis: Outcomes in the Era of Biological Therapy

“…The median time between uveitis onset and cataract surgery in our study was longer in the Biological Group (83.4 months, IQR 20.7–130.6) than in the Non-Biological Group (10.8 months, IQR 3.6–54.9) ( p = 0.03). Long-term corticosteroid use could be one of the reasons associated with a shorter time frame between uveitis onset and cataract development in the Non-Biological Group [ 31 ].…”

Systemic levels of interleukin‐6 in patients with age‐related macular degeneration: a systematic review and meta‐analysis

“…Since chronic low‐grade inflammation is highly associated with risk factors of cataract (e.g. diabetes, smoking, obesity and glucocorticoid use) (Chang et al 2011; Ye et al 2012; Black et al 2016), cataract patients may be an inappropriate control for a study of systemic immunity in patients with AMD. Including cataract patients as controls would likely underestimate a possible difference because of these patients’ presumed underlying systemic state of immunity.…”