An Overview of Rheumatoid Arthritis-Associated Dry Eye Disease, Scleritis, and Peripheral Ulcerative Keratitis

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Rheumatoid arthritis (RA) is a systemic autoimmune disease with potential ocular manifestations.
• Ocular involvement in RA can range from dry eye disease to severe inflammatory conditions like scleritis and peripheral ulcerative keratitis (PUK).

Purpose of the Study:

• To review the clinical features and management strategies for ocular manifestations associated with rheumatoid arthritis.
• To synthesize current literature on the treatment of RA-related eye diseases.

Main Methods:

• A narrative review of publications from PubMed and Google Scholar.
• Inclusion of eligible studies detailing clinical features and management of RA-associated ocular disease.
• Exclusion of unpublished data.

Main Results:

• Dry eye disease (DED) is the most common ocular manifestation, managed with lubrication and topical anti-inflammatories.
• Scleritis and PUK are less common but severe, requiring systemic immunosuppression (corticosteroids, methotrexate, azathioprine, etc.).
• Biologic DMARDs (bDMARDs) like TNF-α inhibitors and rituximab are options for refractory cases, with monoclonal antibodies showing promise.

Conclusions:

• Ocular complications of RA require tailored management based on severity, from topical therapies for DED to systemic immunosuppression and biologics for sight-threatening conditions.
• Further prospective studies are needed to refine treatment algorithms and compare the efficacy of different therapeutic agents, including biologics and targeted synthetic agents.