Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Curr Opin Allergy Clin Immunol. 2022 Oct 1;22(5):304-313. doi: 10.1097/ACI.0000000000000844. Epub 2022 Aug 16.
Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints. Extra-articular manifestations (EAMs) are common and may affect up to 40.6% of patients. Ocular EAM can occur in 39% of the patients. The cornea is involved by different pathogenic mechanisms and corneal disease varies from mild symptoms to severe corneal ulceration and melting with visual loss. Severe corneal involvement is associated with increased mortality in RA patients. We aimed to review the prevalence, mechanisms, management and overall impact of corneal involvement in RA patients.
Corneal involvement is frequent among RA patients. With the wider use of systemic immunosuppression, in particular the disease-modifying antirheumatic drugs (DMARDs), and with improvement of surgical techniques, spontaneous and surgery-related corneal ulceration and melting is becoming less common. However, RA patients are still at risk and should be carefully managed.
RA-related corneal complications are associated with a decreased quality of life and poor ocular and systemic prognosis. Prompt recognition and a multidisciplinary approach involving topical ophthalmic management and systemic immunosuppression are the key factors to maintain ocular integrity and avoid a lethal outcome.
类风湿关节炎（RA）是一种主要影响关节的自身免疫性疾病。关节外表现（EAMs）很常见，可能影响多达 40.6%的患者。眼部 EAM 可发生在 39%的患者中。角膜受累的发病机制不同，角膜疾病从轻微症状到严重的角膜溃疡和融解导致视力丧失不等。严重的角膜受累与 RA 患者的死亡率增加有关。我们旨在综述 RA 患者角膜受累的患病率、机制、管理和总体影响。
RA 患者中角膜受累很常见。随着全身性免疫抑制的广泛应用，特别是疾病修饰抗风湿药物（DMARDs）的应用，以及手术技术的改进，自发性和手术相关的角膜溃疡和融解变得不那么常见。然而，RA 患者仍然存在风险，应谨慎管理。
RA 相关的角膜并发症与生活质量下降以及眼部和全身预后不良有关。及时识别和多学科方法，包括局部眼科治疗和全身免疫抑制，是维持眼部完整性和避免致命后果的关键因素。
