THE PREVALENCE OF EYE INVOLVEMENTS IN RHEUMATOID ARTHRITIS AND THEIR CORRELATION WITH ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODY IN SULAIMANI GOVERNORATE/IRAQ

Authors

  • Rawand Ali Mustafa Sulaimani Directory of Health, Kurdistan Region, Iraq.
  • Raouf Rahim Mirza College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Hemn Raof Rasool Shaheed Aso Eye Hospital, Sulaimani Directory of Health, Ministry of Health, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10412

Keywords:

Rheumatoid Arthritis, Episcleritis, anti-CCP antibody, ocular manifestation, dry eye

Abstract

Background
Rheumatoid arthritis is a common autoinflammatory disease that affects the joints and causes several extra-articular problems, including ocular involvement, which typically manifests in the anterior ocular region. The anti-CCP has a sensitivity comparable to the rheumatoid factor and higher specificity for identifying the disease.


Objectives
To estimate the prevalence of eye involvements in Rheumatoid arthritis and their correlation to the anti-cyclic citrullinated peptide antibody.


Patients and Methods
A cross-sectional study of 121 patients who satisfied the 2010 ACR/EULAR RA Classification Criteria (6/10 or more points) were between 18 and 60. After establishing a patient’s medical history and physical examination, blood samples were collected to test for anti-CCP antibodies, and an eye exam was conducted.


Results
There were significantly more females than males;104 (86%) were female, and 17 (14%) were males. The median age was 47(42−53.5) years. The median disease duration was 4(2−10) years. The mean disease activity was 3.86 ±1, and the median anti-cyclic citrullinated antibody titers were 29.18(16.75−133.35) U/ml. The overall eye complications typical of Rheumatoid arthritis were observed in 37 (30.6%) and 84 (69.4%) without eye involvement. Dry eyes were the most frequent eye complaint (29.8%). One instance with episcleritis (0.8%). One with filamentary keratitis (0.8%). Anterior uveitis was detected in two cases (1.7%). Eye involvement correlated with anti-cyclic citrullinated peptide antibody (P- value 0.004).


Conclusion
Eye manifestations of rheumatoid arthritis were a prominent part of extra-articular manifestation. The dry eye was the most apparent manifestation, and they correlated to the anti-CCP antibody.

References

Van der Woude D, Van der Helm-van Mil AHM. Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol [Internet]. 2018;32(2):174–87. Available from: https://doi.org/10.1016/j.berh.2018.10.005 DOI: https://doi.org/10.1016/j.berh.2018.10.005

Radu AF, Bungau SG. Management of rheumatoid arthritis: An overview. Cells [Internet]. 2021 Apr 27 [cited 2022 Sep 23];10(11):301–15. Available from: https://www.nature.com/articles/s41584-020-0409-1

Lin YJ, Anzaghe M, Schülke S. Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells. 2020;9(4). DOI: https://doi.org/10.3390/cells9040880

Jang S, Kwon EJ, Lee JJ. Rheumatoid Arthritis: Pathogenic Roles of Diverse Immune Cells [Internet]. Vol. 23, International Journal of Molecular Sciences. MDPI AG; 2022 [cited 2022 Sep 14]. p. 905. Available from: https://doi.org/10.3390/ijms23020905 DOI: https://doi.org/10.3390/ijms23020905

Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet [Internet]. 2016 Oct 22 [cited 2022 Aug 8];388(10055):2023–38. Available from: http://dx.doi.org/10.1016/S0140-6736(16)30173-8 DOI: https://doi.org/10.1016/S0140-6736(16)30173-8

Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: Pathological mechanisms and modern pharmacologic therapies. Bone Res [Internet]. 2018;6(1). Available from: https://doi.org/10.1038/s41413-018-0016-9 DOI: https://doi.org/10.1038/s41413-018-0016-9

Shin YS, Choi JH, Nahm DH, Park HS, Cho JH, Suh CH. Rheumatoid factor is a marker of disease severity in Korean rheumatoid arthritis. Yonsei Med J. 2005;46(4):464–70. DOI: https://doi.org/10.3349/ymj.2005.46.4.464

Dai ZW, Wang ZH, Dong YY, Wu Y, Wang HL, Wang DG, et al. Diagnostic value of anti-citrullinated fibrinogen antibody in rheumatoid arthritis: A meta-analysis. Int J Rheum Dis. 2019 Apr 1;22(4):599–607. DOI: https://doi.org/10.1111/1756-185X.13477

Gavrilă BI, Ciofu C, Stoica V. Biomarkers in Rheumatoid Arthritis, what is new? J Med Life. 2016;9(2):144–8.

Yasmin R, Sarker H. Anti-CCP antibody in rheumatoid arthritis patients and its relation with disease severity. BIRDEM Med J [Internet]. 2021 Dec 30 [cited 2022 Jul 9];12(1):36–40. Available from: https://www.banglajol.info/index.php/BIRDEM/article/view/57223 DOI: https://doi.org/10.3329/birdem.v12i1.57223

Kokkonen H, Mullazehi M, Berglin E, Hallmans G, Wadell G, Rönnelid J, et al. Antibodies of IgG, IgA and IgM isotypes against cyclic citrullinated peptides precede the development of rheumatoid arthritis. Arthritis Res Ther [Internet]. 2011 [cited 2022 Jul 17];13(1). Available from: http://arthritis-research.com/content/13/1/R13 DOI: https://doi.org/10.1186/ar3237

Van Der Linden MPM, Knevel R, Huizinga TWJ, Van Der Helm-Van Mil AHM. Classification of rheumatoid arthritis: Comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria. Arthritis Rheum [Internet]. 2011;63(1):37–42. Available from: http://onlinelibrary.wiley.com/journal/10.1002/ DOI: https://doi.org/10.1002/art.30100

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum [Internet]. 2010 [cited 2022 Oct 9];62(9):2569–81. Available from: https://pubmed.ncbi.nlm.nih.gov/20872595/ DOI: https://doi.org/10.1002/art.27584

Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: Extra-articular manifestations and comorbidities. Autoimmun Rev [Internet]. 2021 Apr 1 [cited 2022 Aug 19];20(4):102776. Available from: https://doi.org/10.1016/j.autrev.2021.102776 DOI: https://doi.org/10.1016/j.autrev.2021.102776

Marcucci E, Bartoloni E, Alunno A, Leone MC, Cafaro G, Luccioli F, et al. Extra-articular rheumatoid arthritis. Vol. 70, Reumatismo. Page Press Publications; 2018. p. 212–24. DOI: https://doi.org/10.4081/reumatismo.2018.1106

Bhamra MS, Gondal I, Amarnani A, Betesh S, Zhyvotovska A, Scott W, et al. Ocular Manifestations of Rheumatoid Arthritis: Implications of Recent Clinical Trials. Int J Clin Res Trials [Internet]. 2019;4(2):139. Available from: https://doi.org/10.15344/2456- DOI: https://doi.org/10.15344/2456-8007/2019/139

Lamba N, Lee S, Chaudhry H, Foster CS. A review of the ocular manifestations of rheumatoid arthritis. Cogent Med [Internet]. 2016;3(1):1243771. Available from: https://www.tandfonline.com/action/journalInformation?journalCode=oamd21 DOI: https://doi.org/10.1080/2331205X.2016.1243771

Eldaly ZH, Saad SA, Hammam N. Ocular surface involvement in patients with rheumatoid arthritis: Relation with disease activity and duration. Egypt Rheumatol. 2020 Jan 1;42(1):5–9. DOI: https://doi.org/10.1016/j.ejr.2019.05.004

Artifoni M, Rothschild PR, Brézin A, Guillevin L, Puéchal X. Ocular inflammatory diseases associated with rheumatoid arthritis. Nat Rev Rheumatol [Internet]. 2014 Feb 10 [cited 2022 Sep 5];10(2):108–16. Available from: https://pubmed.ncbi.nlm.nih.gov/24323074/ DOI: https://doi.org/10.1038/nrrheum.2013.185

Evren Kemer O. Dry eye in rheumatoid arthritis. Int Ophthalmol Clin [Internet]. 2017 [cited 2022 Aug 20];57(2):89–99. Available from: https://pubmed.ncbi.nlm.nih.gov/28282316/ DOI: https://doi.org/10.1097/IIO.0000000000000166

Abd-Allah NM, Hassan AA, Omar G, Hamdy M, Abdelaziz STA, Abd El Hamid WM, et al. Dry eye in rheumatoid arthritis: relation to disease activity. Immunol Med [Internet]. 2020;43(2):92–7. Available from: https://doi.org/10.1080/25785826.2020.1729597 DOI: https://doi.org/10.1080/25785826.2020.1729597

Kitazawa K, Inotmata T, Shih K, Hughes J-WB, Bozza N, Tomioka Y, et al. The Impact of ageing on dry eye disease's pathophysiology: A systematic review and meta-analysis. Ocul Surf. 2022 Jul 1;25:108–18. DOI: https://doi.org/10.1016/j.jtos.2022.06.004

Vignesh APP, Srinivasan R. Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies. Clin Ophthalmol [Internet]. 2015 Feb 25 [cited 2023 Jan 29];9:393–7. Available from: https://pubmed.ncbi.nlm.nih.gov/25750517/ DOI: https://doi.org/10.2147/OPTH.S77210

Kaur P, Singh Bal B, Singh B, Duggal A, Kaur I. To Study The Prevalence of Ocular Manifestations in Rheumatoid Arthritis And Their Correlation with Anti Cyclic Citrullinated Peptide Antibodies And Rheumatoid Factor. IOSR J Dent Med Sci [Internet]. 2016 [cited 2022 Aug 8];15(09):58–63. Available from: www.iosrjournals.org DOI: https://doi.org/10.9790/0853-1509105863

Pegu I, Puzari BS, Kakati S, Choudhury G. Ocular Manifestations in Rheumatoid Arthritis and their Co-Relation with Anti Cyclic Citrullinated Peptide Antibodies. Int J Sci Res [Internet]. 2018 [cited 2022 Aug 8];8. Available from: www.ijsr.net

Fadhil R, Al-Dabbagh K. Prevalence and characteristics of eye involvement in patients with rheumatoid arthritis. Zanco J Med Sci [Internet]. 2017 Sep 1 [cited 2022 Aug 8];21(2):1708–14. Available from: https://doi.org/10.15218/zjms.2017.024 DOI: https://doi.org/10.15218/zjms.2017.024

Tsubota K, Yokoi N, Shimazaki J, Watanabe H, Dogru M, Yamada M, et al. New Perspectives on Dry Eye Definition and Diagnosis: A Consensus Report by the Asia Dry Eye Society. Ocul Surf. 2017 Jan 1;15(1):65–76.

Berchicci L, Miserocchi E, Di Nicola M, La Spina C, Bandello F, Modorati G. Clinical features of patients with episcleritis and scleritis in an Italian tertiary care referral centre. Eur J Ophthalmol. 2013;24(3):293–8. DOI: https://doi.org/10.5301/ejo.5000394

Thong LP, Rogers SL, Hart CT, Hall AJ, Lim LL. Epidemiology of episcleritis and scleritis in urban Australia. Clin Exp Ophthalmol. 2020;48(6):757–66. DOI: https://doi.org/10.1111/ceo.13761

Zlatanović G, Veselinović D, Cekić S, Živković M, Dordević-Jocić J, Zlatanović M. Ocular manifestation of rheumatoid arthritis-diff event forms and frequency. Bosn J Basic Med Sci [Internet]. 2010 Nov 1 [cited 2022 Sep 15];10(4):323–7. Available from: https://doaj.org/article/cd3846ebb1bb4082aa876b31591c70f3 DOI: https://doi.org/10.17305/bjbms.2010.2680

Weiss M, Molina R, Ofoegbuna C, Johnson DA, Kheirkhah A. A review of filamentary keratitis [Internet]. Survey of Ophthalmology Jan 1, 2022 p. 52–9. Available from: https://scholars.uthscsa.edu/en/publications/a-review-of-filamentary-keratitis DOI: https://doi.org/10.1016/j.survophthal.2021.04.002

Wu Y, Wang C, Wang X, Mou Y, Yuan K, Huang X, et al. Advances in Dry Eye Disease Examination Techniques [Internet]. Vol. 8, Frontiers in Medicine. 2022. p. 826530. Available from: www.frontiersin.org DOI: https://doi.org/10.3389/fmed.2021.826530

Kervick GN, Pflugfelder SC, Haimovici R, Brown H, Tozman E, Yee R. Paracentral Rheumatoid Corneal Ulceration: Clinical Features and Cyclosporine Therapy. Ophthalmology. 1992;99(1):80–8. DOI: https://doi.org/10.1016/S0161-6420(92)32006-8

Charpentier S, Keilani C, Maréchal M, Friang C, De Faria A, Froussart-Maille F, et al. Corneal Haze post photorefractive keratectomy. J Fr Ophtalmol. 2021 Nov 1;44(9):1425–38. DOI: https://doi.org/10.1016/j.jfo.2021.05.006

Kim SH, Jeong SH, Kim H, Park EC, Jang SY. Development of Open-Angle Glaucoma in Adults with Seropositive Rheumatoid Arthritis in Korea. JAMA Netw Open [Internet]. 2022 Mar 1 [cited 2022 Aug 6];5(3): E223345. Available from: https://jamanetwork.com/ DOI: https://doi.org/10.1001/jamanetworkopen.2022.3345

Avouac J, Gossec L, Dougados M. Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis [Internet]. 2006 Jul 1 [cited 2022 Aug 11];65(7):845–51. Available from: https://ard.bmj.com/content/65/7/845 DOI: https://doi.org/10.1136/ard.2006.051391

Payet J, Goulvestre C, Bialé L, Avouac J, Wipff J, Job-Deslandre C, et al. Anticyclic citrullinated peptide antibodies in rheumatoid and non-Rheumatoid rheumatic disorders: Experience with 1162 patients. J Rheumatol [Internet]. 2014 Dec 1 [cited 2022 Oct 24];41(12):2395–402. Available from: https://www.jrheum.org/content/41/12/2395 DOI: https://doi.org/10.3899/jrheum.131375

Gipson IK. Age-related changes and diseases of the ocular surface and cornea. Investig Ophthalmol Vis Sci. 2013 Dec 1;54(14): ORSF48–53. DOI: https://doi.org/10.1167/iovs.13-12840

Leung YY, Cheung P, Canhão H, Rodrigues AM, Gregório MJ, Dias SS, et al. Common Evaluations of Disease Activity in Rheumatoid Arthritis Reach Discordant Classifications across Different Populations. Front Med [Internet]. 2018 [cited 2022 Dec 22];5:40. Available from: www.frontiersin.org DOI: https://doi.org/10.3389/fmed.2018.00040

Santos IA, de Oliveira RDR, Almeida SCL, Vargas-Santos AB, Amorim RBC, Gomides APM, et al. Comparison of rheumatoid arthritis composite disease activity indices and residual activity in a Brazilian multicenter REAL study. PLoS One. 2022 Sep 1;17(9 September). DOI: https://doi.org/10.1371/journal.pone.0273789

Albidri K, Mohammad NK, Isho F, Al-Bedri K, Al-Quriashi NKM, Gorial FI, et al. Ocular Manifestations in Rheumatoid Arthritis: A Descriptive Cross-Sectional Study from Iraq. J Nat Sci Res [Internet]. 2016 [cited 2022 Sep 5];6(8):118–23. Available from: www.iiste.org

Published

2023-06-21

How to Cite

1.
Mustafa R, Mirza R, Rasool H. THE PREVALENCE OF EYE INVOLVEMENTS IN RHEUMATOID ARTHRITIS AND THEIR CORRELATION WITH ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODY IN SULAIMANI GOVERNORATE/IRAQ. JSMC [Internet]. 2023 Jun. 21 [cited 2024 Jun. 13];13(2):10. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10412

Similar Articles

1-10 of 45

You may also start an advanced similarity search for this article.