Benchérifa Sara, Amine Bouchra, El Binoune Imane, Rostom Samira, Bahiri Rachid
Department of Rheumatology A, El Ayachi Hospital-Salé, CHU Ibn Sina, University Mohammed V-, Rabat, Morocco.
BMC Rheumatol. 2020 Feb 7;4:6. doi: 10.1186/s41927-019-0108-1. eCollection 2020.
Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents.
A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye. A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms.
Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.
周边溃疡性角膜炎（PUK）是一种严重的炎症性眼病，可影响有类风湿关节炎（RA）长期病史的患者。生物疗法的应用彻底改变了RA的治疗方式，并取得了令人鼓舞的成果，尤其是在少数报道的PUK治疗中。在本文中，我们描述了两例有角膜溃疡穿孔病史并合并RA的患者通过生物制剂成功治疗的病例。
一名45岁女性被诊断为血清阳性RA超过17年，对传统合成抗风湿药物（csDMARDs）耐药。她接受过一个周期的利妥昔单抗治疗，但临床和生物学治疗均失败。2017年7月，她出现活动性RA发作，伴有左眼疼痛和视力下降。眼部检查发现左眼角膜穿孔，右眼有穿孔前迹象。她连续三天接受了每天1g甲泼尼龙的紧急推注，随后接受英夫利昔单抗治疗。13个月后，英夫利昔单抗对风湿性疾病和角膜病变有效，因为它阻止了右眼的逐渐穿孔，并稳定了左眼的角膜溃疡。一名68岁男性自2010年起被诊断为血清阳性RA，对csDMARDs耐药，2017年7月并发右眼角膜穿孔。他因眼部病变和活动性RA住院。他连续三天接受了每天500mg甲泼尼龙的紧急推注，随后接受利妥昔单抗治疗。六个月后，我们观察到右眼角膜损伤稳定，关节症状缓解。
我们的病例表明，英夫利昔单抗（病例1）和利妥昔单抗（病例2）作为治疗这种合并活动性RA的严重且破坏性角膜溶解的方法是有效的，从而可以计划进行角膜移植。这种积极的治疗反应将有助于增加该疗法成功的文献报道。
