Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives

Promelle, Véronique; Goëb, Vincent; Gueudry, J.

doi:10.3390/jcm10102118

Cited by 26 publications

(29 citation statements)

References 53 publications

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“…Episcleritis is the second most common ocular manifestation of RA, affecting approximately 1–5% of RA patients [13,32]. The episclera is a thin connective tissue layer that lies between Tenon's capsule and the scleral stroma.…”

Section: Episcleritismentioning

confidence: 99%

Ocular manifestations of rheumatoid arthritis

Reddy¹,

Kolfenbach

Palestine³

2022

Current Opinion in Ophthalmology

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Purpose of reviewThis article summarizes the pathophysiology of rheumatoid arthritis and common ocular manifestations that it is associated with: keratoconjunctivitis sicca, episcleritis, scleritis, and peripheral ulcerative keratitis.Recent findingsNewer biologic agents are being used to effectively treat rheumatoid arthritis and its ocular manifestations.SummaryThe eye is a frequent extra-articular site of inflammation in patients with rheumatoid arthritis. Ocular involvement can range from more benign conditions such as keratoconjunctivitis sicca and episcleritis, to potentially vision and globe-threatening diseases like scleritis and peripheral ulcerative keratitis. Clinicians should be aware of these ophthalmic manifestations and the various treatment options that are available. Coordination between ophthalmology and rheumatology is helpful in the treatment of these patients.

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Section: Episcleritismentioning

confidence: 99%

Ocular manifestations of rheumatoid arthritis

Reddy¹,

Kolfenbach

Palestine³

2022

Current Opinion in Ophthalmology

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“…As the ocular surface plays such a critical role in defense microorganisms and other threats, the eye is susceptible to inflammation or immunologic disorders and shows different ophthalmological manifestations that may be early symptoms in some rheumatic disease cases, ahead of systemic vasculitis (40). This study found ocular microvascular changes which may precede the diagnosis of the underlying RA (41-43).…”

Section: Discussionmentioning

confidence: 99%

Retinal Microvasculature Alteration in Patients with Rheumatoid Arthritis

Lee

2022

Preprint

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BackgroundRheumatoid arthritis (RA) is an autoimmune disease that usually causes synovial inflammation, cartilage and bone deformity, and is associated with the production of rheumatoid factor (RF) and anti-citrullinated protein antibody (1-3). The ocular, cardiovascular and other systemic complications of this disease are of significant concern (4-6). In particular, the eye is susceptible to inflammation or autoimmune disorders and shows ocular manifestations that may be early clinical symptoms of systemic vasculitis in some rheumatic disease cases (7-8). This study used optical coherence tomography angiography (OCTA) to evaluate retinal and conjunctival microvascular alterations in RA patients.MethodsTwelve patients (24 eyes) with a history of at least 5 years of rheumatoid arthritis (RA) were identified from their medical records and compared with 12 normal controls (24 eyes). The microvasculature of each eye was measured quantitatively using OCTA images. The images were manually segmented into representations of two physiologic layers: the superficial retinal layer (SRL) and the deep retinal layer (DRL). The microvascular (SMIR, DMIR), macrovascular (SMAR, DMAR) and total microvascular (STMI, DTMI) density were quantified and calculated in each layer. Simultaneously, macular retinal area was segmented into different regions based on the hemisphere segmentation (SR, SL, IL, and IR), early treatment of diabetic retinopathy study (ETDRS; R, S, L, and I) and central wheel division methods (C1-C6). Microvasculature measurements were used to compare microvascular densities between RA and normal controls and to explore the correlation between microvascular alteration and disease.ResultsCompared with the control group, superficial and deep retinal layer microvascular density was decreased in the RA group. The STMI (p<0.0001), DTMI (p<0.0001), SMIR (p<0.0001), and DMIR (p<0.0001), were lower in RA than in controls, while the SMAR (p=0.207), and DMAR (p=0.828), density was statistically similar between groups. A significant difference was found in both superficial and deep layers in S (p<0.0001), SL (p<0.0001 and p<0.0004 respectively), SR (p<0.0001 and p=0.008 respectively), IL (p<0.0001) and C1 (p<0.0001 and p<0.004 respectively), C2 (p<0.0001 and p=0.0002 respectively), C4 (p=0.02 and p=0.007 respectively) regions, and additionally in the L (p<0.0001), I (p=0.004), C3 (p<0.0001) and C5 (p=0.002), regions in the superficial layer. Similarly, the temporal conjunctival vessel density was found to be lower in RA patients than in controls (t=2.030; P=0.048). In RA group, a statistically positive correlation was indicated between conjunctival microvascular and STMI densities (correlation coefficient 0.712, p=0.02).ConclusionRA is complicated by several severe ocular symptoms and causes superficial and deep microvascular density alteration. This finding could precede diagnosis of the underlying RA and may be a useful factor in early diagnosis and the avoidance of long-term sequelae in systemic rheumatic diseases.

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“…[ 1 ] Approximately 5% of patients with RA may develop episcleritis, and 2% may develop scleritis. [ 2 ] Patients with recurrent or recalcitrant scleritis tend to have persistent circulating antibodies like RF, ANA, and ANCA. [ 3 ] It is mandatory to rule out infectious causes before treatment.…”

Section: Discussionmentioning

confidence: 99%