Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis

Abstract

Objective Rheumatoid Arthritis and other rheumatic diseases may present with ocular manifestations. The purpose of our work was to determine the prevalence and type of eye involvement in rheumatoid arthritis and other connective tissue diseases through a meta-analysis and literature review. Methods A systematic review of the literature was performed using Medline, Web of Science, and the Cochrane library from their inceptions until January 7, 2019. Conjunctivitis, keratoconjunctivitis sicca, xeropthalmia, uveitis, eye hemorrhage, optic neuritis, papilledema, orbital disease, retinal artery/vein occlusion, macular edema, retinitis, chorioretinitis, scleritis, iridocyclitits, choroid hemorrhage, blindness and amaurosis fugax were searched for prevalence in patients with rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, dermatomyositis, polymyositis, systemic sclerosis, Sjogren’s syndrome, undifferentiated connective tissue disease, giant cell arteritis, granulomatosis polyangiitis (GPA; formerly Wegener's granulomatosis), systemic vasculitis, and sarcoidosis. Results 3394 studies were identified and 65 included. The prevalence of eye involvement was 18% in rheumatoid arthritis, 31% in systemic lupus erythematosus, 35% in antiphospholipid syndrome, 27% in giant cell arteritis, 26% in GPA and 27% in sarcoidosis. The most common manifestations was dry eyes (keratoconjunctivitis sicca) in most diseases analyzed with a frequency approaching 90% in Sjogren’s syndrome. Anterior and posterior uveitis were the most common OC in sarcoidosis occurring in 16 [3-28]% and 6 [3-9]% of patients respectively. Conclusion Eye involvement is present in approximately one fifth of rheumatoid arthritis patients, and one quarter to one third of patients with connective tissue diseases (other than Sjogren’s syndrome at 90%) and vasculitis.

Ocular Manifestations in Colombian Patients with Systemic Rheumatologic Diseases

“…Similar studies have reported ophthalmological manifestations in 2–7.7% of their studied population. 16 , 17 , 20 Recently, a systematic review with meta-analysis by Turk et al 21 corroborates our data, as it shows that the ocular involvement in ADs is between 20–33%. These differences may be attributed to the inclusion of a greater number of rheumatologic diseases and ophthalmological diagnoses and symptoms compared to the mentioned similar studies.…”

“…Its prevalence varies between studies, ranging from 10–58%. 22–25 A systematic review and meta-analysis by Turk et al 21 reported a prevalence of 18%. DE and KCS have been reported as the most common ocular manifestation (10–58%), followed by scleritis (1–5%), 21–30 which is very similar to our results.…”

“… 22–25 A systematic review and meta-analysis by Turk et al 21 reported a prevalence of 18%. DE and KCS have been reported as the most common ocular manifestation (10–58%), followed by scleritis (1–5%), 21–30 which is very similar to our results. Other associated ocular manifestations are anterior uveitis (4%), 31 keratitis (3%), 23 and PUK (<1%).…”

Epidemiology of Scleritis in the United Kingdom From 1997 to 2018: Population‐Based Analysis of 11 Million Patients and Association Between Scleritis and Infectious and Immune‐Mediated Inflammatory Disease

“…Future research is needed to establish the population‐based incidence of scleritis in relation to temporal trends in incidence of different I‐IMIDs (29), and to identify effective treatments. We recommend that scleritis and episcleritis not be combined in future epidemiologic studies, given the important differences between them (30).…”

A Good Detective Never Misses a Clue: Why the Epidemiology of Scleritis Deserves Our Attention

“…While the methods used by Braithwaite and colleagues do not allow for predicting the proportion of rheumatic disease patients who will develop scleritis as addressed in some reviews (5), their results highlight scleritis as an important risk factor associated with inflammatory disease in the general population. More than a quarter of patients with scleritis had a history of inflammatory disease, and patients with scleritis were twice as likely to have inflammatory disease compared to the general population.…”