Rheumatoid arthritis and the eye

04/02/2022

Rheumatoid arthritis is an autoimmune disease. The immune system attacks the joints, causing destructive, chronic arthritis. It occurs because of a yet unidentified environmental antigen (perhaps a germ) and the patient's genetics. There exists a genetic disposition, and it is triggered by contact with an external agent.

It effects the larger joints, mainly the hands. Rheumatoid arthritis causes pain, morning stiffness and swelling. And over time, joint deformities appear. 

It's a systemic disease, it can affect other organs. Patients may present with fever, anorexia, pericarditis, vasculitis, pulmonary fibrosis, polyneuropathy, anaemia, ganglions or splenomegaly, etc. and it may be associated with ocular pathologies. Thus, eye manifestations can lead us to suspect a disease with greater scope.

Eye manifestations

Iritis is the most common type of anterior uveitis. Iridocyclitis is another type of anterior uveitis, and both can be associated with rheumatoid arthritis and appear as an isolated cases. The symptoms are acute and intense: redness, pain and photophobia.

Dry keratoconjunctivitis or Sjogren’s syndrome is a chronic autoimmune disease that destroys the lacrimal and salivary glands, causing dryness and chronic symptoms. This dryness may damage the cornea, and even perforate it. It frequently appears in patients with rheumatoid arthritis (secondary Sjogren’s). Around 35% of patients with rheumatoid arthritis have Sjogren’s.

Episcleritis is inflammation of the tissue between the sclera (the white layer that comprises the envelope of the eye) and the conjunctiva (the membrane that covers the sclera). It is an autoimmune disease, but occasionally it is caused by an infection (for example, a flare-up of chicken pox). It causes redness, pain and focal swelling. Inflammation of the sclera and scleritis are less common, as is its most serious form: scleromalacia perforans.

The cornea may be affected by dryness or scleritis, and also ulceration and peripheral thinning, keratolysis (melting) or sclerosing keratitis. Corneal melting is when the cornea melts away or thins and may lead to perforation. These cases are usually acute and sudden with intense pain and visual loss. They usually require prompt treatment with corticoids and immunosuppressive drugs.