From the Guidelines
The diagnostic workup for ocular inflammation to rule out arthritis or other underlying causes should begin with a comprehensive eye examination, including visual acuity testing, slit-lamp examination, intraocular pressure measurement, and dilated fundus examination, as recommended by the 2019 American College of Rheumatology guideline 1. The initial evaluation should aim to characterize the type and extent of inflammation. Key components of the diagnostic workup include:
- Laboratory tests: complete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-nuclear antibody, anti-CCP antibodies, HLA-B27 typing, and angiotensin-converting enzyme levels 1.
- Additional testing may include chest X-ray to evaluate for sarcoidosis, tuberculosis testing, and syphilis serology, as these conditions can also cause ocular inflammation 1.
- Imaging studies such as MRI of the brain and orbits may be necessary if multiple sclerosis or other neurological conditions are suspected. Consultation with rheumatology is recommended for coordinated care, as many ocular inflammatory conditions are manifestations of systemic autoimmune diseases 1. Treatment typically begins with topical corticosteroids like prednisolone acetate 1% four times daily for anterior uveitis, with potential escalation to oral prednisone or immunomodulatory therapy such as methotrexate or biologics like adalimumab for more severe or chronic inflammation 1. This comprehensive approach helps identify underlying causes and guides appropriate treatment to prevent vision loss and manage systemic disease. Regular ophthalmology screening is crucial for early detection of ocular inflammation, especially in children with arthritis, as it can be asymptomatic until complications arise 1. By following this diagnostic workup and treatment approach, clinicians can improve visual outcomes and prevent complications in patients with ocular inflammation.
From the Research
Diagnostic Workup for Ocular Inflammation
To rule out arthritis or other underlying causes of ocular inflammation, a comprehensive diagnostic workup is necessary. The following steps can be taken:
- A thorough medical history to identify any underlying systemic diseases, such as rheumatoid arthritis (RA) 2, 3, 4
- Ocular examination to assess the extent of inflammation and identify any associated ocular conditions, such as episcleritis, scleritis, or peripheral ulcerative keratitis 2, 3, 4
- Laboratory tests, including blood tests to detect inflammatory markers and autoantibodies, such as rheumatoid factor or anti-citrullinated protein antibodies 5, 6
- Imaging studies, such as ultrasound or MRI, to evaluate the extent of ocular or systemic involvement 4
Ocular Manifestations of Rheumatoid Arthritis
Rheumatoid arthritis is a common cause of ocular inflammation, and its ocular manifestations can range from mild to severe. These include:
- Episcleritis, which is usually benign and treated with oral non-steroidal anti-inflammatory drugs (NSAIDs) and/or topical steroids 2
- Scleritis, which can be more severe and require treatment with oral NSAIDs, steroids, and disease-modifying anti-rheumatic drugs (DMARDs) 2, 4
- Peripheral ulcerative keratitis, which can be a vision-threatening condition and requires prompt treatment 3, 4
Collaboration between Ophthalmologists and Rheumatologists
A close collaboration between ophthalmologists and rheumatologists is essential for the diagnosis and management of ocular inflammation associated with rheumatoid arthritis or other underlying causes. This collaboration can help: