Eyes are always uncomfortable, beware of these 5 common rheumatism!

*For medical professionals to read for reference, the eyes are uncomfortable, be careful not to be the "pot" of these rheumatism! When it comes to rheumatic immune diseases, people usually think of joint pain, low back pain, and general pain.
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But in fact, there are more than these that are closely related to rheumatic immune diseases.
Many common rheumatic immune diseases can also cause eye lesions
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Next, let the editor take you to explore the relationship between the two~ Sjögren's syndrome Sjögren's syndrome is an autoimmune disease that affects a variety of exocrine glands.
When the lacrimal gland is involved, it can manifest as dry eye
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Patients with Sjögren's syndrome suffer from insufficient tear secretion, which leads to a decrease in the ability of the eye to lubricate and remove harmful substances, thereby damaging the corneal and conjunctival surface epithelium [1]
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Clinical manifestations include dryness, foreign body sensation, tingling, burning, photophobia, visual fatigue and other discomforts, but lack of specific symptoms
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Keratoconjunctivitis sicca: Due to the reduction of mucin secreted by the lacrimal gland, symptoms such as dry eyes, foreign body sensation, and lack of tears appear.
In severe cases, there is no tears
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Some patients have recurrent purulent infection of the eyelid margin, conjunctivitis, keratitis,
etc.

 Treatment: You can use artificial tears, punctal embolization, and wear therapeutic contact lenses and wet room lenses
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For dry eye caused by Sjögren's syndrome, systemic treatment of the primary disease is very important, and glucocorticoids and immunosuppressive agents should also be applied according to the condition
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 Spondyloarthritis (SpA) SpA is a group of chronic systemic inflammatory diseases characterized by inflammatory low back pain as the main clinical manifestation and inflammation of the spine, peripheral joints and joint tissues, including ankylosing spondylitis, psoriatic arthritis , inflammatory bowel disease arthritis, reactive arthritis and peripheral spondyloarthritis
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Ocular involvement can occur in any type of SpA, and about 1/3 of patients present with uveitis, which is also the most common extra-articular manifestation of SpA [2]
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The uvea includes the iris, ciliary body, and choroid, and uveitis is divided into anterior, middle, posterior, and panuveitis according to the anatomical structures involved
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Among them, unilateral acute anterior uveitis (AAU) is the most common type of SpA-related ocular inflammation, accounting for about 60% to 90%, and about 50% of patients may experience relapse
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In addition, patients with SpA may also develop posterior uveitis, episcleritis, scleritis, and keratitis
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Figure 1 Acute anterior uveitis (source document) SpA-related AAU is characterized by acute onset of iris and ciliary body inflammation, and patients with ankylosing spondylitis and reactive arthritis are more likely to have typical AAU, often unilateral attacks, and some patients Alternating attacks in both eyes; psoriatic arthritis or inflammatory bowel disease arthritis may present with atypical manifestations, including bilateral attacks, insidious onset, chronic disease, non-anterior uveitis (eg, intermediate uveitis, etc.
)
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Figure 2 Iritis (source document) SpA-related AAU is more prone to recurrence, and the interval between attacks varies from several weeks to several years
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Generally, recurrence is more frequent in the early stage of the disease, and the recurrence frequency decreases with the prolongation of the disease course
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Treatment: Patients with uveitis should be screened early for a timely diagnosis of underlying SpA
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Most patients with SpA-related uveitis are effectively treated with topical corticosteroids, but relapsed and refractory patients require systemic corticosteroids, disease-modifying antirheumatic drugs (DMARDs), or biological agents
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Behçet's disease Behçet's disease is a chronic autoimmune disease that can affect multiple systems of the body such as the gastrointestinal tract, skin, cardiovascular, and central nervous system, and is characterized by recurrent oral ulcers, genital ulcers, ophthalmia, and skin lesions.

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Ocular lesions of Behcet's disease can be manifested as anterior uveitis, posterior uveitis, retinal vasculitis, empyema, secondary glaucoma, cataract, visual loss and iris adhesion, which mostly occur within 3 years of onset , both eyes can be involved, the most common damage is uveitis, and the blindness rate is as high as 14.
5% to 25% [3]
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Treatment: The disease often presents alternate recurrences and remissions, leading to irregular medication use, which is one of the prognostic factors for patients.
Therefore, early diagnosis, timely and regular treatment, and close monitoring of disease activity are very important for improving the prognosis of patients with ophthalmia
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 Systemic lupus erythematosus (SLE) SLE can affect various parts of the eyeball.
Many SLE patients have ocular complications, which can lead to severe visual impairment and even blindness if left untreated [4]
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Patients with SLE can develop anterior uveitis, posterior uveitis, and uveitis secondary to scleritis, manifesting as pain, photophobia, redness, lacrimation, a sense of floater in the eye, and visual impairment
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The typical manifestations of SLE with retinopathy are cotton wool spots.
Fundus fluorescein angiography shows the occlusion of precapillary arterioles and the formation of non-perfused areas of capillaries.
Cotton wool spots can appear alone or accompanied by retinal edema, ischemia, and rigidity.
Exudation and bleeding
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A small number of SLE patients developed severe retinal arteriitis obliterans during the course of the disease, with a sharp decline in visual acuity
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In addition to the above-mentioned microangiopathy, SLE can also cause occlusion of some large blood vessels, such as central retinal artery, ciliary retinal artery, and central or branch retinal vein occlusion, which can lead to more severe vision loss and worse prognosis
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 Figure 3 Treatment of retinal vasculitis (source document): Systemic corticosteroids are the drug of choice for the treatment of severe ocular complications of SLE
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When glucocorticoids cannot control the disease or the inflammation cannot be completely controlled after more than 3 months of treatment, immunosuppressive drugs such as cyclophosphamide, azathioprine, and methotrexate must be used
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Biologics also play a role in the treatment of SLE and ocular complications
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 Rheumatoid Arthritis (RA) RA is mainly an immune-mediated inflammatory injury, and immune-inflammatory response is a common mechanism for the pathogenesis of various types of dry eye
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Immune cells in lacrimal gland tissue can be activated by various pathogenic causes of RA to cause inflammation
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Inflammation of the lacrimal gland and ocular surface can lead to damage and apoptosis of lacrimal gland and ocular surface epithelial cells, resulting in decreased secretion of watery fluid and mucus in tears [5]
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In addition, uveitis may occur in young patients and scleritis in adults, possibly due to vasculitis
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There may also be dry conjunctival keratitis, scleromalacia, scleromalacia perforation, and corneal dissolution
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Treatment: The treatment of dry eye secondary to RA is to develop some methods to promote tear secretion and correct its underlying causes on the basis of supplementing artificial tears and tear retention, such as the use of artificial tears and lubricants, glucocorticoids and immune system.
inhibitor therapy,
etc.

 Summary If it is determined that the eye lesions are caused by rheumatic immune diseases, you should seek medical attention as soon as possible to control the primary disease
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In this way, targeted treatment of eye lesions will be more effective
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In addition, patients should also avoid prolonged eye use, stay up late, and pay attention to eye hygiene
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Reference [1] Wu Yuan, Rong Bei, Yan Xiaoming.
Consistency analysis of ocular symptoms and signs in patients with Sjögren's syndrome[J].
Ophthalmology, 2010(3):4.
[2]Li Lu, Zhao Chan, Liu Jinjing , et al.
Progress in the diagnosis and treatment of spondyloarthritis-associated uveitis[J].
Journal of Clinical Internal Medicine, 2021, 38(5):4.
[3]Chen Zhanrui, Fu Fana, Zhao Cheng.
Investigation on the clinical characteristics of Behcet’s disease complicated with ophthalmia Analysis[J].
Frontiers of Medicine, 2019, 9(29):3.
[4]Li Jing, Gao Yingying.
Ocular manifestations and treatment progress of systemic lupus erythematosus [J].
Chinese Journal of Clinicians (Electronic Edition), 2011 , 005(012):3581-3584.
[5]Jia Ye, Lai Zhaoguang.
The pathogenesis and drug treatment status of dry eye secondary to rheumatoid arthritis[J].
Modern Diagnosis and Treatment, 2013(1):2.
[6] Hart C, Ferdinands M, Barnsley L.
Ocular complications of rheumatic diseases.
Med J Aust.
2017; 206(5): 224-228.