Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies

Abstract

PurposeTo study the ocular manifestations of rheumatoid arthritis and to correlate the role of anti-cyclic citrullinated peptide antibody (anti-CCP antibody) with the ocular manifestations.MethodsThree-hundred and ninety-two eyes of the 196 rheumatoid arthritis patients who attended the ophthalmology outpatient department underwent a detailed ocular examination using slit lamp biomicroscopy and ophthalmoscopy. The tear function of all the patients was assessed using Schirmer’s test, tear film break-up time and ocular surface staining. The anti-CCP antibody titers for all the rheumatoid arthritis patients were estimated using enzyme-linked immunosorbent assay tests.ResultsSeventy-seven patients (135 eyes, 39%) out of the 196 patients studied had ocular manifestations typical of rheumatoid arthritis. Dry eye was the most common manifestation (28%, 54 patients). Of the patients, 78% was females (60 patients). The mean duration of rheumatoid arthritis in patients with ocular manifestations was 5.4±2.7 years and without ocular manifestations was 2.1±1.6years. Three percent of the patients had episcleritis (six patients). Scleritis was present in 2% of the patients (four patients). Peripheral ulcerative keratitis and sclerosing keratitis was present in 1% of the population each (two patients each). Eighty-five percent (66 patients) had bilateral manifestations 15% (eleven patients) had unilateral manifestations. There was a strong association between the presence of anti-CCP antibodies and ocular manifestations of rheumatoid arthritis which was shown by the statistically significant P-value of <0.0001.ConclusionOcular manifestations are a significant part of the extra-articular manifestation of rheumatoid arthritis. Dry eye was the most common ocular manifestation. There was a statistically significant association between the presence of anti-CCP antibodies specific to rheumatoid arthritis and the ocular manifestations.

Influence factors of extra-articular manifestations in rheumatoid arthritis

“…All of these OMs are both sight-and life-threatening ones because of their association with systemic vasculitis [16]. A risk factor found in this study was ACPA, as reflected by another report that the presence of ACPA was significantly associated with OMs [17] and was the most prevalent biomarker among RA patients [18]. Therefore, ACPA can be both diagnostic and prognostic and can be easily detected before the occurrence of EAMs [19].…”

Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment

“…In the last century, anticitrullinated protein antibodies were discovered. However, anticyclic citrullinated peptide antibodies (anti-CCP antibodies) are more sensitive than RF, and they are special markers of systemic involvement in RA [ 50 ]. Compared with RF, anti-CCP appears to be related to increased and worse ocular manifestation in RA [ 51 ].…”

Study of Factors Influencing Dry Eye in Rheumatoid Arthritis

“…RA is mainly considered as a joint disease, but it has the capacity to inflict multiple organs because of the abnormal systemic immune response. About 17.8–47.5% of patients present the extra-articular manifestations [ 12 , 13 ], among which the ocular surface manifestation is the most common [ 14 , 15 ], which seriously affects the quality of life [ 16 ]. Earlier studies have shown that synovitis is the pathological basis for joint injury in RA [ 5 ].…”