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Journal of Peking University(Health Sciences) >

2021 , Vol. 53 >Issue 6: 1032 - 1036

DOI: https://doi.org/10.19723/j.issn.1671-167X.2021.06.004

Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis

  • Liang LUO ,
  • Wen-gang HUO ,
  • Qin ZHANG ,
  • Chun LI
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  • 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 date: 2021-08-16

  Online published: 2021-12-13

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

Cite this article

Liang LUO , Wen-gang HUO , Qin ZHANG , Chun LI . Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis[J]. Journal of Peking University(Health Sciences), 2021 , 53(6) : 1032 -1036 . DOI: 10.19723/j.issn.1671-167X.2021.06.004

References

[1] Jayaraj K, Alvin G, Charles S, et al. Correlation of ocular manifestations with the duration and activity of disease in patients with rheumatoid arthritis[J]. Int J Med Sci, 2017, 6(1):34-37.
[2] Hamideh F, Prete P. Ophthalmologic manifestations of rheumatic diseases[J]. Semin Arthritis Rheum, 2001, 30(4):217-241.
[3] Foster CS, Forstot SL, Wilson LA. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis: effects of systemic immune suppression[J]. Ophthalmology, 1984, 91(10):1253-1263.
[4] Zandavalli F, Castro G, Mazzucco M, et. al. Infliximab is effective in difficult-to-control peripheral ulcerative keratitis. A report of three cases[J]. Rev Bras Reumatol, 2015, 55(3):310-312.
[5] Aletaha D, Neogi T, Silman J, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology / European League Against Rheumatism Collaborative Initiative[J]. Arthritis Rheum, 2010, 62(9):2569-2581.
[6] Yoshida M, Hariya T, Yokokura S, et al. Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients[J]. Am J Ophthalmol Case Rep, 2020, 18:100648.
[7] Artifoni M, Rothschild R, Brézin A, et al. Ocular inflammatory diseases associated with rheumatoid arthritis[J]. Nat Rev Rheumatol, 2014, 10(2):108-116.
[8] Watanabe R, Ishii T, Yoshida M, et al. Ulcerative keratitis in patients with rheumatoid arthritis in the modern biologic era: a series of eight cases and literature review[J]. Int J Rheum Dis, 2017, 20(2):225-230.
[9] Harrold R, Shan Y, Rebello S, et al. Prevalence of Sjögren’s syndrome associated with rheumatoid arthritis in the USA: an observational study from the Corrona registry[J]. Clin Rheumatol, 2020, 39(6):1899-1905.
[10] Singh S, Das V, Basu S. Ocular involvement in Sjögren syndrome: risk factors for severe visual impairment and vision-threatening corneal complications[J]. Am J Ophthalmol, 2021, 225:11-17.
[11] Maseda D, Bonami R, Crofford L. Regulation of B lymphocytes and plasma cells by innate immune mechanisms and stromal cells in rheumatoid arthritis[J]. Expert Rev Clin Immunol, 2014, 10(6):747-762.
[12] Galor A, Thorne J. Scleritis and peripheral ulcerative keratitis[J]. Rheum Dis Clin North Am, 2007, 33(4):835-854.
[13] Wang F, Misra L, Patel V. In vivo confocal microscopy of the human cornea in the assessment of peripheral neuropathy and systemic diseases[J]. Biomed Res Int, 2015, 2015:951081.
[14] Sainz M, Foster S, Jabbur S, et al. Ocular characteristics and disease associations in scleritis-associated peripheral keratopathy[J]. Arch Ophthalmol, 2002, 120(1):15-19.
[15] Knox NE, Tole DM, Georgoudis P, et al. Peripheral ulcerative keratitis and corneal melt: a 10-year single center review with historical comparison[J]. Cornea, 2014, 33(1):27-31.
[16] 祝磊, 王丽娅, 张俊杰, 等. 0.05%他克莫司滴眼液治疗难治性免疫相关角膜溃疡的疗效及安全性研究[J]. 中华实验眼科杂志, 2015, 33(9):823-827.
[17] 杨纪忠, 李冰. 类风湿关节炎相关性边缘角膜溃疡临床分析[J]. 山西医药杂志, 2009, 38(8):748-749.
[18] Bonnet I, Rousseau A, Duraffour P, et al. Efficacy and safety of rituximab in peripheral ulcerative keratitis associated with rheumatoid arthritis[J]. RMD Open, 2021, 7(1):e001472.
[19] Lucia D, Lara S, Vanesa R, et al. Biologic therapy in severe and refractory peripheral ulcerative keratitis (PUK). Multicenter study of 34 patients[J]. Semin Arthritis Rheum, 2020, 50(4):608-615.
[20] Puéchal X, Gottenberg E, Berthelot M, et al. Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: results from the autoimmunity and rituximab registry[J]. Arthritis Care Res, 2012, 64(3):331-339.
[21] Peter K, Dirk B, Susann A, et al. Rapid healing of peripheral ulcerative keratitis in rheumatoid arthritis with prednisone, methotrexate and adalimumab combination therapy[J]. Rheumatology (Oxford), 2017, 56(7):1094.
[22] Messmer M, Foster S. Vasculitic peripheral ulcerative keratitis[J]. Surv Ophthalmol, 1999, 43(5):379-396.
[23] Messmer M, Foster S. Destructive corneal and scleral disease associated with rheumatoid arthritis: medical and surgical management[J]. Cornea, 1995, 14(4):408-417.
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