Clinical Eye Manifestations Associated with Rheumatoid Arthritis

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Clinical Eye Manifestations Associated with Rheumatoid Arthritis

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized primarily by persistent synovial joint inflammation, leading to progressive joint destruction, deformity, and disability (Smolen et al., 2016). Beyond joint involvement, RA is associated with a wide range of extra-articular manifestations that affect organs such as the lungs, skin, cardiovascular system, and eyes (McInnes & Schett, 2017).

Ocular involvement is one of the most clinically significant extra-articular complications of RA. The eye is particularly vulnerable due to immune-mediated inflammation of ocular tissues and secondary effects of systemic vasculitis (Akpek et al., 2011). Common eye-related complications in RA include keratoconjunctivitis sicca (dry eye disease), episcleritis, scleritis, uveitis, and peripheral ulcerative keratitis, some of which can threaten vision if not treated promptly (Watson & Hayreh, 2014).

Dry eye disease is the most prevalent ocular manifestation in RA and often occurs as part of secondary Sjögren’s syndrome. It results from immune-mediated destruction of the lacrimal glands, leading to reduced tear production and ocular surface damage (Vivino et al., 2012). More severe conditions such as scleritis and peripheral ulcerative keratitis are associated with systemic vasculitis and carry a high risk of corneal perforation and visual loss (Jabs et al., 2015).

Despite advances in RA management, many patients remain unaware of ocular complications until significant symptoms develop. Early detection through routine ophthalmologic screening is therefore essential for preventing irreversible visual impairment (Akpek & Smith, 2013). This study focuses on eye-related complications among individuals with rheumatoid arthritis, with the aim of improving awareness, early diagnosis, and integrated care.

1.2 Statement of the Problem

Although rheumatoid arthritis is widely recognized as a joint disease, its ocular complications are often under-diagnosed and under-reported, especially in low- and middle-income settings (Kuriya et al., 2010). Many patients with RA do not undergo regular eye examinations, even though ocular involvement may be asymptomatic in the early stages.

Late presentation of conditions such as scleritis and peripheral ulcerative keratitis can result in corneal scarring, perforation, and permanent visual loss (Watson & Hayreh, 2014). Furthermore, the use of disease-modifying antirheumatic drugs (DMARDs) and biologic therapies may also contribute to ocular side effects if not properly monitored (Singh et al., 2016).

The lack of local data on the prevalence, patterns, and risk factors of ocular complications in RA patients limits effective planning for screening and management. This study therefore seeks to investigate eye-related complications among individuals with rheumatoid arthritis in order to promote early intervention and multidisciplinary care.

1.3 Aim of the Study

The main aim of this study is to assess eye-related complications among individuals with rheumatoid arthritis.

1.4 Objectives of the Study

The specific objectives are to:

Determine the prevalence of ocular complications among patients with rheumatoid arthritis.

Identify the common types of eye-related complications in RA patients.

Examine the relationship between disease duration, disease activity, and ocular involvement.

Assess patients’ awareness of ocular complications associated with rheumatoid arthritis.

1.5 Research Questions

What is the prevalence of eye-related complications among individuals with rheumatoid arthritis?

What types of ocular manifestations are most common in RA patients?

Is there a relationship between RA disease duration and ocular complications?

What is the level of awareness of eye complications among RA patients?

1.6 Significance of the Study

This study will be beneficial to:

Patients, by increasing awareness of potential eye complications and the importance of regular eye examinations.

Clinicians and Ophthalmologists, by providing evidence to support routine ophthalmic screening in RA management.

Health policymakers, by highlighting the need for integrated rheumatology–ophthalmology services.

Researchers, as it will add to existing literature on extra-articular manifestations of RA, particularly ocular involvement.

1.7 Scope of the Study

This study focuses on individuals diagnosed with rheumatoid arthritis and attending selected healthcare facilities. It is limited to the assessment of ocular complications related to RA and does not include other systemic extra-articular manifestations.

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