Ocular manifestations of Rheumatoid arthritis.

Summary Rheumatoid arthritis is the most common inflammatory arthritis of rheumatoid diseases which are group of immune mediated multisystem diseases.To find out the clinical ocular manifestations of rheumatoid arthritis & to ensure the importance of ophthalmologic assessment for each patient with rheumatoid arithritis.56 patients attendant to the rheumatological unite in Al-Diwaniya Teaching hospital, examined by (Visual acuity, slit lamp biomicroscopy, tonometry, tear breakup time, Schirmer test, & fundoscopy).of 56 patients; 18(32%) had positive ocular findings. The most common finding was dry eye; 9(18%) of patients.Key


Introduction
Rheumatoid diseaseses are group of immune mediated multisystem diseases, which could be seropositive such as rheumatoid arithritis (RA) & systemic lupus erythmatosus (SLE) or seronegative such as ankylosing spondylitis, psoriasis, Rieter disease, and others. [1] Rheumatoid arthritis is the most common inflammatory arthritis and hence an important cause of potentially preventable disability, clinically it is deforming, small and large joints polyarthritis, often associated with systemic disturbances. The clinical course is usually life long, with intermittent exacerbations and remission. The prevalence of the disease is more common and increases with age, with 5% of women, and 2% of men over 55 years being affected .[1], [2] RF is an autoantibody directed against IgG immunoglobuline. It can be detected by a variety of tests including sheep red blood cell agglutination, and enzyme linked immunosorbant assay (ELISA), RF is a useful marker for the presence of rheumatoid arithritis. Criteria for diagnosis of Rheumatoid arithritis: (according to the American Rheumatism Associations 1988) *Morning stiffness>1 hour. *Arithritis of three or more joints. *Arithritis of hand joints. *Symmitrical arithritis. *Rheumatoid nodule. *Rheumatoid factor. *Radiological changes. *Duration of 6 weeks or more.
The extra-articular manifestations usually caused by systemic inflammation; anorexia, weight loss, and fatigue are the most common, fallowed by muscluskeletal (osteoporosis, and tenosynovititis), heamatological (anemia, thrombocytopenia, and, easonophilia), cardiac (pericarditis, myocaraits, and endocaradits), pulmonary (nodules, pulmunary effssion, fibrosing alveolitis), neurological (cervicel cord compression, and compressive neuropathies). The opthlmologial features are of two aspects 1st one results from the disease itself and the other from the medication used such as Chlorquine and systemic steroid.
[1], [3] In juvenile rheumatoid arthritis the eye is often white and uninflammed in appearance. Symptoms may range from no pain to moderate pain, photophobia, and blurring. Often, the eye disease is found incidentally during routine examination.
Children with rheumatoid arthritis should have at least each six months slit lamp examination. Chronic inflammation result in peripheral anterior synechiae, posterior synechia, cystoid macular odema, vitreous opascification, cataract, and chronic calcific band keratopathy. In severe cases secondary glaucoma, and cyclitic membrane .

Resuls
The incidence of ocular lesions in that study is 32%; 37.5%, of males, and 32.2% of females as shown in the table below. Keratoconjunctivitis sicca (Drye eye) was the most frequent positive ocular manifestations; it affects 16% of patients.
Two cases of juvenile rheumatoid arthritis, one of them had no positive ocular findings while the other one affected by chronic anterior uvietis, posterior synaechia, and cataract. Keratoconjunctivitis sicca (Drye eye) was the most frequent positive ocular manifestations; it affects 16% of patients which is slightly less than that founded Gordana, and the above mentioned searchers. We haven't notice any case affected by keratitis, and or peripheral corneal melting . [9] Two cases of juvenile rheumatoid arthritis, one of them had no positive ocular findings while the other one affected by chronic anterior uvietis, posterior synaechia, and cataract, this findings go with that founded by Cassidy & Kotaniemi…et al .

Frequency distribution of positive ocular manifestations in relation to
[11], [12] Side effects of long term steroid founded in two cases, both of them have posterior sub capsular cataract, and open angle glaucoma.

Conclusions
We have two aspects of ocular affections in Rheumatoid arthritis 1 st one is the disease itself the other one is the side effects of its treatment such as steroids, and or disease modifying drugs, so each patient should has opthalmological assessment.