Ocular inflammatory manifestations in patients with rheumatoid arthritis

Purpose

This review emphasizes the significance of clinical findings, pathogenic mechanisms, diagnosis, management, and complications related to the ocular manifestations of rheumatoid arthritis, underscoring the need for interdisciplinary collaboration between rheumatologists and ophthalmologists.

Methods

A comprehensive literature search was conducted using PubMed, Embase, Web of Science, and Google Scholar for all English-language articles published from inception to July 2024. The following search string was utilized: (“rheumatoid arthritis”) AND (“dry eye disease” OR “dry eye” OR “episcleritis” OR “scleritis” OR “peripheral ulcerative keratitis” OR “central corneal ulcer*” OR “paracentral corneal ulcer*” OR “ocular manifestations” OR “ocular involvement”). Letters to the editor, editorials, short communications, case reports, case series, review articles, and original articles were reviewed, along with relevant references from those publications.

Results

The most common ocular manifestations in patients with rheumatoid arthritis include keratoconjunctivitis sicca (dry eye disease), episcleritis, scleritis, peripheral ulcerative keratitis, and central and paracentral corneal ulceration. Ocular involvement can be the initial presentation of the disease and may correlate with disease activity. If left untreated, ocular inflammation in rheumatoid arthritis can lead to permanent vision loss.

Conclusions

The diverse ocular inflammatory manifestations in RA patients may indicate either the disease's initial presentation or the status of extra-articular activity. A multidisciplinary approach that includes rheumatologists and ophthalmologists is essential to prevent sight-threatening complications.