There are over 1.3 million people living with rheumatoid arthritis (RA) in the U.S. Although RA commonly affects the joints, it can also affect other organs, such as the eyes. Eye complications are among the most commonly reported medical conditions in people living with RA. In fact, studies have shown that 30 percent to 40 percent of people diagnosed with RA also experience eye problems such as dry eyes, red eyes, or severe eye pain.
To understand the relationship between rheumatoid arthritis and eye conditions, myRAteam sat down with Dr. Jeffrey Sparks. Dr. Sparks is a rheumatologist and clinical researcher who specializes in rheumatoid arthritis, allergy, and immunology at Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts.
The eye is composed of many structures and layers, and because of this, RA can cause a variety of eye problems and symptoms.
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“The most common way [rheumatoid arthritis] affects the eyes is due to secondary Sjogren’s syndrome, which is a disease of dryness that often affects any mucous membrane, particularly the mouth and eyes,” Dr. Sparks said. Studies have shown that dry eye disease develops in 18 percent to 90 percent of people with RA.
One myRAteam member wrote, “I’ve had RA for 16 years, but over the past four months I developed eye pain and eye dryness. It felt as if something was always stuck inside my eyes and it would also burn and sting. As soon as I described my symptoms to my rheumatologist, she diagnosed me with secondary Sjogren’s syndrome.”
Peripheral ulcerative keratitis (PUK) is another eye condition that people with RA may develop over time. PUK affects the structure in the front of the eye, called the cornea, and causes inflammation and thinning of the cornea. RA is the most frequent underlying disease in people with PUK.
Symptoms of PUK include redness, pain, sensitivity to light (photophobia), tearing, blurry vision, and loss of vision.
Scleritis is rare in people with RA, but it can be quite dangerous if left untreated because it causes thinning of the white part of the eye (called the sclera). This increases a person’s risk of tearing their eyeball(s) and/or developing vision loss. A person may experience symptoms such as deep or burning eye pain, inflammation, photophobia, blurry vision, and sometimes vision loss.
One myRAteam member described their difficulty dealing with RA and scleritis: “I am having a bad flare-up with my eyes over the past few days. My eyes are blurry, sensitive to the light, and they are both bloodshot red. My doctor told me my scleritis was caused by my rheumatoid arthritis.”
Uveitis is caused by inflammation inside the structure of the eye called the uvea. Symptoms include eye pain, redness, blurry vision, photophobia, and dark spots that float in the eye called floaters.
Uveitis is rarely found in people living with RA. However, when it does occur, it is more commonly found in younger people. “Interestingly, people that are diagnosed with juvenile inflammatory arthritis are more likely to develop uveitis than people that have adult-onset RA,” said Dr. Sparks. “It’s quite uncommon, but there is a small percentage — about 1 percent to 2 percent of people with RA experience a severe form of uveitis.”
If uveitis is not managed properly, these inflammatory eye conditions can lead to scarring, permanent vision loss, and other eye diseases, such as glaucoma.
It is not well understood how rheumatoid arthritis directly causes dry eye syndrome, scleritis, or uveitis. However, studies have shown that RA damages the connective tissues that surround the ends of the joints. Connective tissue is entirely made up of collagen, which also primarily makes up the eye. Therefore, an inflammatory response caused by RA can also cause swelling and inflammation that leads to tissue damage within the eyes.
Although there is no cure for RA, there are ways to prevent and manage these eye conditions. It is advised that anyone living with RA should have an eye exam from an ophthalmologist every year, or as soon as they experience any eye symptoms such as itching, redness, pain, or vision loss. No matter how minor eye symptoms may seem, it’s important to let your rheumatologist or eye doctor know of any new or unusual eye-related symptoms.
Dr. Sparks stresses the importance of having rheumatologists and ophthalmologists work together to create the best preventive care plan for those diagnosed with RA: “Specialized ophthalmologists are really needed to help the rheumatologist think about the particular type of eyedrops, lubricants, or even injections that they might consider in [people living with RA] that have varying forms of inflammatory eye disease.”
Managing and treating eye conditions goes hand in hand with keeping a person’s RA symptoms under control. For dry eyes, Dr. Sparks suggests using “local lubricating agents, such as eyedrops” for short-term relief.
One myRAteam member shared their positive experience with eyedrops. “I am now doing eyedrops multiple times a day and using an eye gel at night. My eyes are starting to feel a little better. Before, I would blink and it felt like sandpaper rubbing over my eyeballs.”
For inflammatory eye conditions such as PUK, scleritis, and uveitis, immune system-reducing drugs (immunosuppressants), and topical or oral steroids (corticosteroids) are initially used to reduce the body’s inflammatory response to the eyes. However, long-term steroid use can negatively affect a person’s vision and may lead to the development of other eye diseases, such as cataracts or glaucoma.
Nonsteroidal anti-inflammatory drugs like ibuprofen, eyedrops, or injections might be used as an alternative treatment. It is important to discuss treatment plans with your rheumatologist and/or ophthalmologist to help preserve your overall vision.
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