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Category: Volume 09 Issue 04 April 2021
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Title: A Clinical study on Ophthalmic Manifestation of Rheumatoid Arthritis based on patients attending Rheumatology Department of Medical College Hospital, Thiruvananthapuram, South Kerala

Authors: S. Rema Devi, Jacob Antony

 DOI: https://dx.doi.org/10.18535/jmscr/v9i4.26

Abstract

Background: Rheumatoid Arthritis (RA) is an auto Immune chronic Inflammatory disorder of worldwide distribution and it causes painful and destructing articular conditions.  Extra articular manifestation in RA are more common in sero +ve patients.  The extra articular manifestations includes, epicarditis, pleuritis, major cutaneous, vasculitis, ophthalmic manifestations, glomerulo nephritis, and other type of vasculitis. Ophthalmic manifestation caused by RA causes severe ocular morbidities if not screened at an early stage.

Materials and Methods: A hospital based prospective observational study on patient attended at Rheumatology Department of Medical College, Thiruvananthapuram who have diagnosed as Rheumatoid arthritis were examined and called for detailed ocular evaluation at RIO Clinic.  A total of 198 cases were screened during August 2019 to January 2021.  All patients were subjected to detailed history, pertaining to age, duration of the disease systemic manifestation of RA, drug history and its duration and symptoms related to ophthalmic manifestation were collected. Protocol based treatment were offered after detailed ophthalmic evaluations tests and effect of treatment was studied during follow up periods.  Data of the patients were recorded on a pre-fabricated proforma.  Data was statistically analysed by chi-square analysis odds ratio and Logistic regression analysis.

Results: 115 (58.08%) patients of RA (Rheumatoid arthritis) showed Ophthalmic manifestations KCS. (dry eye manifestations) was the most common complications which responds well to artificial tear substitutes on daily application. Complications like episcleritis scleritis and iridocyclitis and keratitis were noted out and active emergency strategies were given to avoid ophthalmic morbidities and this helped to alleviate the problems of severe Vn Impairment.  Drugs related to ocular complications like quinolen toxicity and posterior sub capsular opacity due to steroid toxicity were ruled out and strict follow up measures were given along with the guidance of the Rheumatologist.

Conclusion

  1. Rheumatoid arthritis is also a systemic auto immune disease have signs and symptoms of the eye.
  2. KCS (Dry Eye manifestation) were the commonest complication.
  3. Early Ophthalmolgic interference and active treatment regimen can reduce further extent of ocular morbidities and thus Vn threatening conditions.

Keywords: Rheumatoid arthritis, peripheral Ulcerative keratitis, hydroxy- chloroquine, kerato conjunctivitis sicca, Non steroidal anti inflammatory drugs, posterior sub capsular cataract.

References

  1. ALAN J Silman and Jacqueline E Pea soon Epidemiology and Genetics of RA : Arthritis Res.2002, 4,S.265-S 272.
  2. PATEL S J and Lundy D.C. (2002) Ocular Manifestation of Auto – Immune Disease 66.
  3. D.J., TANZER D J and Smith R.E. (1998), Rheumatoid disease International Opthal Clinics, 38, 47-80. http:idx_doi.org/10. 1097/0000 4397 – 199803840-00007.
  4. Gordo DA, Stein J L Brodei E The extra articular features of R A AMJ Med/54 : 445, (1973)
  5. Lille by V, Gran J T., Tidsskr Nor Laege Foren 1997 ; 117 : 4223-5.
  6. Charanyac, Swathi A., Jantis Pandurangan.R., Ocular Manifestation IN RA Patients presenting IN Tertiary Care Hospital in South India A prospective study Int. JSCI Stud 2015 ; 3 (8) 61-66).
  7. A., Suni L, Deodhar S D et al Extra Articular Manifestation among North India patients RA Journal of Indian Rheumatism Association 1997 ; 5 (3) 75-8.
  8. Reddy SC, Gupta S.D Jain I.S Deodhar S D Ocular Manifestations of Rheumatoid Arthritis Indian J Ophthalmol 1977 25 : 20-6.
  9. Moss S E, K lein R., Klein B E, Prevalence of and risk factors for dry eye syndrome Arch Opthalmol 2000 118 : 126-4.
  10. Felson D T AND ERSON J J, Boers M Bombardier C, Furst D, Goldsmith C et al. American College of Rheumatology, Preliminary definition of improvement IN Rheumatoid Arthritis Rheum 1995 ; 38, 727-35.
  11. Kalke. S D Perera, N D Patel, T.E.Gordar, B.Das Gupta Rheumatoid volume 40, Issue 2, Feb.2001, Pages 170-177.
  12. Toda 1 Fujishuma H, T Subotak, Ocular Fatique is the major component of dry eye Acta. Ophthalmol 71; 347-352, 1993.
  13. M Yamamoto J Hirata C.E Goldbey CA, Yoschinari N.H and Bonfa.E., (2008) Ege disease in a patient with Rheumatoid arthritis Vogt – Koyanagi Harady Syndrome and Rheumatoid Arthritis.
  14. Meghner L S., Bron A.J., Tongu S.R., Gilbert D.J effect of fluorescen. Instillation on the pre-corneal tear film stability curr eye Res. 4: 9 – 12 
  15. Bandem – Roche K et al : Challenges to defining and quantifying dry eye.  Invest Ophthalmol Vis. Sci. 36 : S 862, 1995.
  16. Watson PG, Hayreh S S, Scleritis and Episcleritis Br.J Ophthalmol 1976 : 60 : 163-91.
  17. MC GAVIN DD, Willianson J, Forrester J V., Foulds W.S., Buchanan W W, Dick W C et al Episcleritis and scleritis. A study on their clinical manifestation and assosication with Rheumatoid Arthritis Br. J Opthalmol 1976 : 60 – 192-226.
  18. S.L., Foster.C.S., (1998) The Ocular Manifestation of R.A. International Opthalmology Clinics, 38, 1-19. http://dx.doi./org/ 10. 1097/00004397 – 199803810 – 00003.
  19. MC GAVIN D D William Son.J, Forrester.J.V., Foulds, W.S Buchanan W.W.Dick W.C. et al; (1976) Episcleritis and Scleritis. A study on their Clinical Manifestation and association with Rheumatoid Arthritis.  British Journal of Ophthalmology 60: 192 – 226.  http// dx.doi.org/10.1136/610.60. 3:192.
  20. Wake field D, MC closky.P. Cyclosporin therapy for severe scleriotis. J. Ophthalmol/ 1989:73 743-6.
  21. RAO NA, FONTRL. Pseudo Rheumatoid Nodule of the Ocular Adenexa. AMJ Ophthalmol 70 : 471.
  22. A, Balakrishnan.C., Gaitonde.S., Mittal.G., Pathan E, Gokhale.N.S/ and Joshi V.R. (2002) Rheumatoid Corneal melt. Rheumatology 41-705-706. http:/dx:doi-Org./10. 1093/ Rheumatology/41.6.705.
  23. A, Ijiris, Sugiyamak D Pasculae M.A. Tseng SC. Detection of Corneal Epithelial defect through amniotic membrane patch by Fluorescein : Cornea 2005. 24:359 – 60.
  24. Del Castillo, B.J.M., Diaz – Valle D, Pato, E. Abad.L.C. and Ale jandre.N (2008). Articular disease and Uveitis Anales del sislema Sanitario de Navarra.31.
  25. M.F., Kellner U., Lai. T.Y., Lyons.J.S. and Mieler, w.f. (2011). American Academy of Ophthalmology Revised Recommendation on screening for chloroquine and  Hydroxy Chloroquine, Retinopathy.
  26. Oglesby R.B., Black.R.L., Saltman L Ven and Bunin.J.J 196/Arch Ophth. 66.519.
  27. Reddy SC, Gupta.S.D., Jain.I.S., Deodhar.S.D., Ocular Manifestation of RA Indian J Ophthalmol 1977, 25 : 20-6.
  28. Thompson M, Eadie.S Kerato Conjunctivities SICCA and Rheumatoid Arthritis ANN Rheum Dis. 1956 : 15:21.

Corresponding Author

S Rema Devi

Assistant Professor, Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala 695 035, India