Retinal vasculitis in two patients with rheumatoid arthritis: A case-based review

Background

Rheumatoid arthritis (RA) is a systemic autoimmune disease that can be associated with extra-articular manifestations including vasculitis that occurs exceptionally in the retina.

Aim of the work

To present two active RA cases with retinal vasculitis (RV) and compare them to similar cases presented worldwide.

Case presentations

The first case was a 44-year-old male patient with seropositive and erosive RA with a sudden bilateral blurred vision and myodesopsias and developed bilateral occlusive venous RV. It occurred concomitantly with an increased disease activity (disease activity score 4.4) that was treated with high doses of prednisolone. Then the patient had a recurrence of RV with another flare-up of his RA disease. Workup of RV included markers of infection, antinuclear antibody (ANA) and anti-neutrophil cytopasmic antibody (ANCA) and all were negative. The patient received pulse intravenous corticosteroids and was transitioned to oral steroids with the addition of methotrexate 20 mg/week with a favorable outcome. The second case was a 33-year-old female with history of bilateral retinal detachment treated surgically, followed for seronegative non-erosive RA. She presented with left RV complicated by a preretinal hemorrhage. Workup of RV included markers of infection and autoimmune markers were negative. A magnetic resonance imaging (MRI) hands showed bony erosions at the metacarpophalangeal joints with bilateral active synovitis. Systemic steroids were initiated with articular and visual improvement.

Conclusion

The retina should be examined for evidence of vasculitis in RA and RV should be kept in mind as an ocular complication or association.