Abstract
ObjectiveGlucocorticoids (GCs) are often used to treat Rheumatoid Arthritis (RA) despite their many side effects and the availability of other effective therapies. Cataract and glaucoma are known side effects of GCs but the risk of them developing in the setting of GC use for RA is unknown. The aim was to perform a systematic review and meta-analysis to determine the association between GCs and the risk of developing cataract and/or glaucoma in RA.MethodsA systematic search was carried out using MEDLINE, EMBASE, and Web of Science. All RCTs comparing GC use to non-use in RA populations were sought. Observational studies reporting cataract and/or glaucoma amongst GC users and non-users were also included. Data extracted included incidence/prevalence of cataract and/or glaucoma in each arm, dose and duration of therapy. Two independent reviewers performed quality assessment.Results28 RCTs met eligibility criteria, however only 3 reported cataracts and glaucoma, suggesting significant under-reporting. An association between GC use and the development of cataracts in RA patients was seen in observational studies but not RCTs. There was no statistically significant association between GC use and the development of glaucoma, although data were sparse. There were insufficient data to determine the impact of dose and duration of therapy.ConclusionThe current literature suggests a possible association between GC use and the development of cataract. However, this risk cannot be accurately quantified in RA from the available evidence. RCTs have not adequately captured these outcomes and well-designed observational research is required.
Highlights
Cataract and glaucoma were first described as side effects of systemic GC therapy as early as 1953[1, 2]
An association between GC use and the development of cataracts in rheumatoid arthritis (RA) patients was seen in observational studies but not randomised controlled trials (RCTs)
There were no significant differences in the risk of developing cataracts for GC-exposed versus unexposed RA patients, either individually by trial, or collectively in the meta-analysis (RD 0.01 events/patient, 95% CI -0.01–0.03), Fig 2 (A risk difference (RD) of 0.01 equates to an additional 10 cataracts for every 1000 patients exposed to GCs compared to those unexposed)
Summary
Cataract and glaucoma were first described as side effects of systemic GC therapy as early as 1953[1, 2]. GC exposure can lead to steroidinduced glaucoma, a type of open angle glaucoma. These conditions can lead to visual impairment, resulting in significant disability and cost to the healthcare system [3]. For cataract and glaucoma, the magnitude of risk is rarely reported and current literature has not been reviewed to determine if the risk can be accurately quantified. Specific questions, such as how this is influenced by dose and duration of therapy, have not yet been addressed. There are multiple randomised controlled trials (RCTs) of GC use in RA, and long-term use has been looked at in many observational studies, making it an ideal setting to explore these questions
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