Ocular Manifestations In Rheumatoid Arthritis Patients Attending The Rheumatology Clinic At The Kenyatta National Hospital

Abstract

Background: RA is the most common systemic autoimmune disease and affects middle aged women three times more often than men in a percentage of 0.5 - 2% of the general population. Approximately 25% of patients with RA will have ocular manifestations. Dry eye is the most common ophthalmic manifestation, with a reported prevalence of 15-25%. In our setting there was no recent study on ocular manifestations in patients with RA and this study was to address this gap. Objective: To determine the prevalence and pattern of ocular manifestations in patients with rheumatoid arthritis at the rheumatology clinic of Kenyatta National Hospital. Methods: This was a cross-sectional study done in Kenyatta National Hospital rheumatology clinic between April 2017 to May 2018. The study population included patients who are 18 years above diagnosed with Rheumatoid arthritis according to the 2010 ACR/EULAR criteria for the diagnosis of RA by rheumatologists at KNH. The patients were consecutively enrolled in the study during their clinic visits. Statistical analysis was done using the SPSS program version 23.0. Ocular manifestations were presented as percentages and chi square test used to test associations. Results: Fifty-nine (59) patients were studied. The mean age was 51.4 years and 89.8% were females. More than a third had more than 5 years’ duration of the RA disease. Ocular manifestation was diagnosed in 96.6% of the patients and some patients had more than one manifestation. Dry eye syndrome was the most common manifestation at 93.2% while others had cataract (22%) and episcleritis (10.2%). DES and cataracts were associated with older age and those on steroids had a lower prevalence of blepharitis (p=0.040). Duration of RA disease was not associated with ocular manifestations. Visual acuity was normal for 93.2% of the patients. Conclusion: The prevalence of ocular manifestations is very high in RA patients mainly due to DES which occurs in 9 out of 10 patients Recommendation: All patients diagnosed with RA should be referred to an ophthalmologist for evaluation of ocular co-morbidities.