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de Figueiredo LQ, de Andrade Lopes FO, Franco AS, Giardini HAM, Guedes LKN, Bonfiglioli KR, Shimabuco AY, de Medeiros Ribeiro AC, Domiciano DS. Scleromalacia perforans as an early manifestation of late-onset rheumatoid arthritis: a case-based review. Rheumatol Int 2024; 44:1165-1173. [PMID: 37925382 DOI: 10.1007/s00296-023-05494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 11/06/2023]
Abstract
Rheumatoid arthritis is a chronic autoimmune disease that can affect different organs beyond the joints. Ocular involvement includes keratoconjunctivitis sicca, peripheral ulcerative keratitis (PUK), episcleritis, scleritis, anterior uveitis, and corneal impairment. The most severe form of scleritis, scleromalacia perforans, is an aggressive ophthalmic manifestation that can potentially lead to blindness, usually occurring in late stages of disease. We report a case of an elderly woman in which this severe ocular manifestation occurred early on disease onset, differing from most of the previously reported cases of scleromalacia perforans. Ocular symptoms started concomitantly with the polyarthritis and other extra-articular manifestations, including rheumatoid nodules and vasculitic skin lesions. Ocular disease progressed due to patient's loss to follow-up, requiring pulse therapy with methylprednisolone. However, despite treatment, right eye enucleation was required due to melting of the corneal patch with uveal exposition. The patient was then treated with rituximab with improvement of systemic disease. The present case reinforces that, although rare, this complication is severe and must be promptly diagnosed and aggressively treated to improve prognosis of ocular and systemic RA.
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Affiliation(s)
- Letícia Queiroga de Figueiredo
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Fernanda Oliveira de Andrade Lopes
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - André Silva Franco
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Henrique Ayres Mayrink Giardini
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Lissiane Karine Noronha Guedes
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Karina Rossi Bonfiglioli
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Andrea Yukie Shimabuco
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Ana Cristina de Medeiros Ribeiro
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Diogo Souza Domiciano
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
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Reddy AK, Kolfenbach JR, Palestine AG. Ocular manifestations of rheumatoid arthritis. Curr Opin Ophthalmol 2022; 33:551-556. [PMID: 36165413 DOI: 10.1097/icu.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This 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 FINDINGS Newer biologic agents are being used to effectively treat rheumatoid arthritis and its ocular manifestations. SUMMARY The 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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Affiliation(s)
| | - Jason R Kolfenbach
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Gurlevik U, Karakoyun A, Yasar E. When rheumatoid arthritis is mentioned, should only dryness come to mind? Clin Rheumatol 2020; 39:3317-3321. [PMID: 32388745 DOI: 10.1007/s10067-020-05124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate corneal parameters of rheumatoid arthritis (RA) patients by corneal topography. METHODS One hundred two RA patients and 60 control subjects were enrolled. Corneal topography measurements and ophthalmologic findings were examined from all participants' files. RESULTS Corneal thickness measurements were significantly lower in the RA group (p = 0.025). All values of corneal curvatures (K1, K2, Kmean) in 3 mm, 5 mm, and 7 mm zones were found statistically significantly higher in the RA group compared with the control group. Forty-five RA patients had a dry eye. Disease duration was correlated with dry eye in the RA group. There was a significant correlation between the duration of disease in RA patients and mean corneal curvatures (p 0.012/0.010/0.007, 3/5/7 mm respectively) and central corneal thickness (p 0.025). There is no statistical difference between other topographic measurements. CONCLUSIONS The results suggest that RA patients have thinner and steeper corneas compared with control subjects. These parameters change in negative correlation as the duration of the disease increases. Key Points • Rheumatoid arthritis is an autoimmune disease with systemic involvement. • In rheumatoid arthritis, systemic involvement is affected in the eyes. • When it comes to eye involvement, it comes to mind that it makes the eyes more dryness. • In addition to dryness in the eyes, rheumatoid arthritis makes morphological changes in the cornea.
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Affiliation(s)
- Ugur Gurlevik
- Ophthalmology Department, Faculte of Medicine, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey. .,Physical Therapy and Rehabilitation Department, Faculte of Medicine, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey.
| | - Ahmet Karakoyun
- Ophthalmology Department, Faculte of Medicine, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey.,Physical Therapy and Rehabilitation Department, Faculte of Medicine, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey
| | - Erdogan Yasar
- Ophthalmology Department, Faculte of Medicine, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey.,Physical Therapy and Rehabilitation Department, Faculte of Medicine, Aksaray Education and Research Hospital, Aksaray University, Aksaray, Turkey
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