Peripheral corneal ulceration associated with rheumatoid arthritis

Abstract

AbstractPurpose To report a case of a patient with rheumatoid arthritis (RA) and associated peripheral corneal ulceration.Methods A 60 year old woman with RA diagnosed 15 years ago, and under immunosuppressive therapy (IV abatacept 250 mg / month), demonstrated blurring of vision in her right eye. Visual acuity was 6 / 10 in the right eye and 10 / 10 in the left eye. Slitlamp examination revealed a paracentral superior corneal melt in the right eye. Anterior chamber reaction was 2+. Laboratory investigations revealed negative Extractable Nuclear Antigens (ENA) Screen ELISA Test, negative anti‐Sm antibodies, positive serum IgG and IgA reactivities, and IgE and IgM within normal levels. Evaluation for the underlying connective tissue disease revealed highly elevated Rheumatoid Factor and C‐reactive protein (CRP) (955 IU/ml, normal range: 0‐20 IU/ml, and 1.59 mg/dl, normal range: 0‐0.8 respectively). The patient underwent extensive treatment with topical tobramycin and lubricants and oral prednisolone 60 mg/day with tapering doses, and methotrexate p.os. 15 mg / week was added.Results The condition was improved within a few days after the initiation of prednisolone treatment. Re‐epithelization occurred one week after the onset of the treatment and only punctate fluorescein dye uptake was detected in the margins of the lesion.Conclusion The effective control of the underlying disease and early diagnosis of the dry eye syndrome in RA patients may prevent serious corneal complications, such as corneal ulceration, which are difficult to treat. The initiation of treatment with steroids and immunosuppresants was found to halt the progression of keratolysis and assist re‐epithelization.