الفهرس 
Rheumatoid arthritisOnly 14 pages are availabe for public view
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Abstract
RA is an immune-mediated inflammatory disorder that primarily affects the
synovial joint and can result in deformity and disability but also has extra articular
manifestations including vascular and eye affection.
The choroid of eye is a vascular network located between retina and sclera that
nourish the outer layer of retina. Spectral-domain optical coherence tomography (OCT)
using enhanced depth imaging (EDI) is newly used as a non-invasive safe method for
better visualization of the choroid. The aim of this work is to evaluate the choroidal
thickness in rheumatoid arthritis patients and detect its relation to disease activity. Ethical
written an informed consent was obtained from all subjects after a full explanation of
the study according to the ethical committee of faculty of medicine, Menoufia
University.
Fifty patients suffering from Rheumatoid arthritis (46 female & 4 male) who had
attended the outpatient clinic of physical medicine Rheumatology & Rehabilitation
department, Menoufia University Hospitals from 2017 to 2021 were included in this
study. All patients were diagnosed as RA according to the 2010 criteria of the American
College of Rheumatology for RA.
We examined their both eyes with OCT to evaluate the choroidal thickness in
rheumatoid arthritis patients and detect its relation to disease activity. Their disease
duration ranged from 2 to 18 years with a mean of 5.94 ± 3.48 years. One hunderd eyes
of 50 healthy controls (45 females, 5 males) that were examined with OCT to assess
normal choroidal thickness. The mean age of the RA patients was 34.18 ± 4.01
(range 19–39), and the control group was 32.54 ± 5.75 (range 18–39). There was no
significant difference between the mean ages of the two groups according to the
Student’s t test (p = 0.101). The male/female distribution of the two groups compared
was similar. Patients presented with morning stiffness, joint pain, joint swelling
involving especially small joints of the hands, deformities. Diagnosis was made
according to the 2010 criteria of the American College of Rheumatology for RA.
Evaluation of inflammatory activity was made using the Disease Activity Score (DAS-
28). Larsen score is used for the radiographic evaluation of joint damage.
Exclusion criteria were prior history of intraocular surgery, prior history of
ocular trauma, previous ocular disease such as retinal detachment, episcleritis, scleritis
and uveitis. Smoking and alcohol use, diabetes mellitus, hypertension, glaucoma,
pregnancy and high myopia or hypermetropia (>6 diopters).
All patients were subjected to the following: demographic data, clinical
assessment including medical history and clinical examination (general, complete joint
examination, neurological examination and Ophthalmic examination), laboratory
investigation including CBC, ESR, CRP, RF and Anti-CCP and imaging including
Posterior-anterior radiographs of the hands and choroidal thickness was measured by
enhanced depth imaging (EDI) optical coherence tomography (OCT) for both eyes of
every subject.
Subfoveal choroidal thickness was measured by Heidelberg spectral domain
OCT (Heidelberg Engineering, Heidelberg, Germany) and software version 6.3.3.0. A
superluminescent diode with a wavelength of 870 nm was used. The digital calipers provided by the Heidelberg Spectralis software were used to measure CT horizontally at
the subfoveal region. CT was measured from horizontal sections obtained by OCT
under the center of the fovea by the same ophthalmologist and averaged for analysis.
Disease Activity Score 28 (DAS-28) was used to measure disease activity in patients.
The score was calculated using the number of tender and swollen joints and the erythrocyte sedimentation rate. RA patients were divided into 2 subgroups as remission
(DAS-28 ≤ 2.6) and active (DAS-28> 2.6).