Ocular Complications Common Across Spectrum of Rheumatic Diseases

Eye exam
Optometrist performing visual field test
Between one-fifth and one-third of patients with rheumatoid arthritis, connective tissue disease, and vasculitis have ocular complications.

Between one-fifth and one-third of patients with rheumatoid arthritis (RA), connective tissue disease, and vasculitis have ocular complications, according to study results published in The Journal of Rheumatology. Researchers found that dry eyes, glaucoma, and anterior uveitis were the most common ocular manifestations involved in these inflammatory rheumatic disorders.

For this study, Canadian researchers performed a systematic review and meta-analysis of 65 studies that reported the prevalence of ocular involvement in patients with RA, connective tissue disease, or vasculitis. In studies of RA, the pooled prevalence rate of ocular involvement was 18% (95% CI, 15-22).

Among other rheumatic diseases, the pooled prevalence rates for ocular involvement were 31% (95% CI, 18-44) in studies of systemic lupus erythematosus, 35% (95% CI, 3-67) in studies of antiphospholipid syndrome, 27% (95% CI, 18-36) in giant cell arteritis, 26% (95% CI, 19-34) in granulomatosis polyangiitis, and 27% (95% CI, 18-36) in sarcoidosis.

The most common ocular complications in studies of RA were dry eye and glaucoma, with prevalence rates of 16% (95% CI, 11-20) and 5% (95% CI, 0-13), respectively. In Sjogren syndrome, the most common ocular manifestation was also dry eyes, which was found in 89% (95% CI, 86-92) of patients.

In a similar fashion, dry eye was most common ocular complication in systemic lupus erythematosus (33%; 95% CI, 24-42) and systemic sclerosis (27%; 95% CI, 22-32). In sarcoidosis, the most common ocular manifestations were anterior uveitis (16%; 95% CI, 3-28) and posterior uveitis (6%; 95% CI, 3-9). Ocular manifestations appeared to occur more frequently in adults vs children with RA (28% [95% CI, 19-37] vs 13% [95% CI, 12-14], respectively; P =.0035).

Limitations to the study included the high heterogeneity between studies as well as the lack of differentiation between causes of ocular complications (ie, disease activity vs treatment).

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The finding of ocular involvement in 18% of patients with RA highlights “it as a common extra-articular manifestation of the disease,” the researchers wrote. “Extra-articular symptoms can be improved with certain treatment and improve quality of life for patients with RA.”


Turk MA, Hayworth JL, Nevskaya T, Pope JE. Ocular manifestations in rheumatoid arthritis, connective tissue disease and vasculitis: a systematic review and meta-analysis. J Rheumatol. 2020;47(5):190768.