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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (6): 1032-1036. doi: 10.19723/j.issn.1671-167X.2021.06.004

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Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis

LUO Liang1,2,HUO Wen-gang3,ZHANG Qin4,△(),LI Chun1,△()   

  1. 1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Rehabilitation, Chongqing Rehabilitation Hospital of Integrated Traditional and Western, Chongqing 400013, China
    3. Department of Rheumatology and Immunology, Hebei Yiling Hospital, Shijiazhuang 050091, China
    4. Department of Ophthalmology, Peking University People's Hospital, Beijing 100044, China
  • Received:2021-08-16 Online:2021-12-18 Published:2021-12-13
  • Contact: Qin ZHANG,Chun LI E-mail:tonimck@sina.com;13811190098@163.com
  • Supported by:
    Beijing Natural Science Foundation(7192211)

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Abstract:

Objective: To investigate the clinical characteristics, risk factors and prognosis of ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA). Methods: Sixteen patients with UK (the UK group) were screened among 4 773 RA patients hospitalized at Peking University People’s Hospital from January 2003 to May 2021, and 72 patients with RA without UK in the control group were selected by propensity score matching (PSM). The clinical features, laboratory data and medications between the two groups were collected and analyzed. Results: The average age of the patients with RA was 60 years at the time of the complication of UK. UK appeared on average in the 16th year of RA, with the majority of UK occurring in the 7th year of RA and beyond (14 cases), however, a minority of UK was the first symptom of RA (1 case). UK associated with RA manifested as simple marginal UK in 8 cases, marginal UK with perforation in 5 cases, marginal UK with uveitis in 2 cases and central UK with perforation in 1 case. The number of swollen joints was significantly higher in the UK group than in the control group [6.0(2.5,23.0) vs. 3.0(1.0, 9.8), Z=-2.047, P=0.041], and the proportion of secondary Sjögren syndrome (SS,37.5% vs. 6.9%, χ2=11.175, P=0.004) and interstitial lung disease (ILD, 37.5% vs. 8.3%, χ 2=9.456, P=0.008) were significantly higher in the RA patients with UK than the patients without UK. The uses of sulfasalazine (12.5% vs. 48.6%, χ 2=7.006, P=0.008), leflunomide (31.3% vs. 63.9%, χ 2=5.723, P=0.017) and gold salt(6.3% vs. 33.8%, χ 2=4.841, P=0.032)were significantly lower in the UK group than in the control group. However, there was no statistically significant comparison between the two groups for the 28-joint disease activity score-erythrocyte sedimentation rate (5.3±1.8 vs. 5.1±1.6, t=0.309, P=0.761). Logistic analysis showed the number of swollen joints (OR=1.148), secondary SS (OR=79.118), complicated with ILD (OR=6.596) and the use of sulfasalazine (OR=0.037) were independent relevant factors (P<0.05) for UK in RA patients. Conclusion: The number of swollen joints, secondary SS, complicated with ILD and the use of sulfasalazine are independent relevant factors for UK in patients with RA.

Key words: Rheumatoid arthritis, Ulcerative keratitis, Relevant factor

CLC Number: 

  • R593.22

Figure 1

Two types of ocular manifestations of ulcerative keratitis A, marginally ulcerative keratitis; B, central ulcerative keratitis with perforation."

Figure 2

Ocular manifestations of ulcerative keratitis after treatments. A, marginally ulcerative keratitis after 2 weeks of topical application of glucocorticoid; B, central ulcerative keratitis after 10 months with multi-layer amniotic membrane repair."

Table 1

Clinical manifestations and laboratory parameters between the two groups"

Items UK group (n=16) Control group (n=72) Z/t/χ2 P
ESR/(mm/H), $\overline{x}$±s 57.4±38.3 50.3±30.7 0.839 0.404
CRP/(mg/L), M (P25, P75) 15.8 (5.4, 42.3) 11.2 (3.2, 38.6) -0.155 0.877
Anti-CCP/(U/mL), M (P25, P75) 303.0 (97.5, 650.0) 100.0 (33.3, 300.0) -0.879 0.379
RF/(IU/mL), M (P25, P75) 222.0 (144.2, 266.4) 125.5 (18.5, 293.8) -1.862 0.063
TJCs, M (P25, P75) 7.0 (1.0, 16.5) 7.0 (2.0, 15.8) -0.836 0.836
DJCs, M (P25, P75) 1.5 (0, 10.0) 0 (0, 4.0) -1.899 0.058
SJCs, M (P25, P75) 6.0 (2.5, 23.0) 3.0 (1.0, 9.8) -2.047 0.041
Secondary SS, n (%) 6 (37.5) 5 (6.9) 11.175 0.004
DAS28-ESR score, $\overline{x}$±s 5.3±1.8 5.1±1.6 0.309 0.761
Complicated with ILD, n (%) 6 (37.5) 6 (8.3) 9.456 0.008
Rheumatoid nodules, n (%) 3 (18.8) 3 (4.2) 4.382 0.122

Table 2

The Medications between the two groups"

Parameters UK group (n=16) Control group (n=72) χ2 P
HCQ/% 25.0 59.7 1.304 0.392
MTX/% 37.5 56.9 0.166 0.784
SASP/% 12.5 48.6 7.006 0.008
GS/% 6.3 33.8 4.841 0.032
LEF/% 31.3 63.9 5.723 0.017
GC/% 31.3 54.2 1.135 0.404
Biologics/% 6.3 81.9 1.364 0.450
Untreated/% 43.8 25.0 2.263 0.218

Table 3

Binary Logistic analysis results of risk factors related to RA with UK"

Parameters B Wald P OR 95%CI
SJCs 0.138 5.875 0.015 1.148 1.027-1.284
Secondary SS 4.371 8.333 0.004 79.118 4.068-1 538.736
ILD 1.886 4.230 0.040 6.596 1.093-39.813
SASP -3.288 4.494 0.034 0.037 0.002-0.780
LEF -1.696 2.485 0.115 0.183 0.022-1.511
GS -1.219 0.567 0.623 0.451 0.012-7.042
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