From the Research
Rheumatoid arthritis (RA) patients have an increased risk of developing retinal diseases, particularly those taking certain medications, and should receive comprehensive eye examinations annually, with more frequent monitoring if on high-risk medications or with pre-existing eye conditions. The relationship between RA and retinal disease is complex, with shared inflammatory pathways playing a significant role. According to a recent systematic review 1, RA itself can cause scleritis, episcleritis, and keratoconjunctivitis sicca (dry eye syndrome), which may require artificial tears, topical anti-inflammatories, or in severe cases, punctal plugs.
Some key points to consider:
- Hydroxychloroquine, commonly prescribed for RA, requires regular eye screening due to its potential to cause retinopathy, with recommended baseline examination before or within the first year of treatment, then annual screening after 5 years of use (or earlier with risk factors) 1.
- TNF inhibitors like etanercept and adalimumab can rarely cause demyelinating optic neuritis and should be discontinued if visual symptoms develop 1.
- Glucocorticoids may increase the risk of cataracts and glaucoma, requiring regular eye pressure monitoring 1.
- Methotrexate has minimal direct retinal effects but can cause conjunctivitis and dry eyes 2, 1.
- The connection between RA and retinal disease stems from shared inflammatory pathways, with TNF-alpha and other cytokines playing roles in both conditions 1, 3.
In terms of specific recommendations, patients with RA should have their ocular health monitored closely, particularly if they are taking medications that may increase the risk of retinal disease. This is supported by a recent study 4, which highlights the importance of considering ocular health in the management of RA patients. Additionally, a study on the ocular surface findings in patients with RA treated with methotrexate or biological agents found that there was a statistically significant difference between the two groups in terms of tear film break-up time, central corneal thickness, and intraocular pressure 2.
Overall, the management of RA patients requires careful consideration of their ocular health, and comprehensive eye examinations should be performed annually, with more frequent monitoring if necessary.