Romatoid artrit ve ankilozan spondilit hastalarında göz bulgularının değerlendirilmesi

Yıl 2014, Cilt: 11 Sayı: 1, 28 - 33, 01.04.2014

Dicle Turhanoğlu Abdullah Erman Yağız Nilgül Üstün Esra Ayhan Tuzcu Hayal Güler

Öz

Amaç: Romatoid artrit ve ankilozan spondilitte eklem bulguları dışında göz tutulumları da görülebilmektedir. Bu çalışmanın amacı, romatoid artrit ve ankilozan spondilit hastaları arasında göz tutulumu sıklığını, tipini belirlemek ve hastalık aktiviteleri ile arasındaki ilişkiyi değerlendirmektir.Metaryal ve metod: Çalışmamıza 37 romatoid artritli ve 47 ankilozan spondilitli hasta alınmıştır. Hastalarda tam kan sayımı, biyokimyasal parametreler, eritrosit sedimentasyon hızı, C-reaktif protein düzeylerine bakılmıştır. Hastalık aktivitesi romatoid artritli hastalarda hastalık aktivite skoru 28, ankilozan spondilitli hastalarda ise bath ankilozan spondilit hastalık aktivite indeksi ile değerlendirilmiştir. Ankilozan spondilitli hastaların spinal hareket durumlarını belirlemede bath ankilozan spondilit metroloji indeksi kullanılmıştır. Tüm hastalara ayrıntılı göz muayenesi göz kliniğinde aynı hekim tarafından yapılmıştır. Bulgular: Çalışmamızda romatoid artritli hastaların %35.1'inde kuru göz, %13.5'unda punktat keratit, %8.1'inde arka subkapsüler katarakt saptanmıştır. Romatoid artritli hastalarda kuru göz ile yaş, hastalık süresi, hastalık aktivite skoru, eritrosit sedimentasyon hızı, ve C-reaktif protein değerleri arasında anlamlı ilişki bulunamamıştır p>0.05 . Ankilozan sponilit hastalarının %19.1'inde göz kuruluğu, %17.1'inde glokom, %10.6'ınde üveit, %6.4'ünde subkapsüler katarakt saptanmıştır. Ankilozan spondilitli üveiti olan hastaların hastalık süresinin olmayanlara göre anlamlı olarak daha yüksek olduğu belirlenmiştir p= 0.036 . Ancak üveiti olan hastalarla olmayanlar arasında yaş, hastalık aktivite indeksi, metroloji indeksi, eritrosit sedimentasyon hızı ve C-reaktif protein değerleri arasında anlamlı ilişki bulunamamıştır p>0.05 . Sonuç: Bu çalışmada sonuç olarak, romatoid artritli ve ankilozan spondilit hastalarında kuru göz en sık rastlanan göz bulgusudur. Ankilozan spondilitli hastalarda üveit ile hastalık süresi arasında anlamlı ilişki saptanmıştır. Ancak hastalık aktivite göstergeleriyle romatoid artritli hastalarda kuru göz, ankilozan spondilitli hastalarda üveit arasında anlamlı bir ilişki bulunamamıştır

Anahtar Kelimeler

Romatoid artrit, ankilozan spondilit, göz bulguları

Evaluation of oculer findings in rheumatoid arthritis and ankylosing spondylitis patients

Öz

Backgraund: Also except the articular findings, the eye involvement can be seen in rheumatoid arthritis and ankylosing spondylitis. The aim of this study is to determine the the incidence and type of ocular involvement, and to assess the relationship between the disease activities and ocular findings.Methods: Thirty-seven rheumatoid arthritis patients and 47 ankylosing spondylitis patients were included in our study. The complete blood count, biochemical parameters, erythrocyte sedimentation rate, C-reactive protein levels were measured. The disease activities were evaluated by disease activity score 28 in patients with rheumatoid arthritis and bath ankylosing spondylitis disease index in patients with ankylosing spondylitis. Bath ankylosing spondylitis metrology index was used to determine the status of the spinal motion in ankylosing spondylitis patients. The comprehensive eye examination of all patients were performed by the same physician at the outpatient clinic. Results: In our study, 35.1% dry eye, 13.5% punctate keratitis, 8.1% posterior subcapsular cataracts were determined in patients with rheumatoid arthritis. No significant association was found between dry eye and age, disease duration, disease activity score, erythrocyte sedimentation rate, and C-reactive protein levels in rheumatoid arthritis patients p>0.05 . Also, 19.1% dry eye, 17.1% glaucoma, 10.6% uveitis, 6.4% subcapsular cataracts were determined in patients with ankylosing spondylitis. The duration of illness of patients with uveitis were found to be significantly higher than those without uveitis in ankylosing spondylitis p= 0.036 . However, no significant association was found between uveitis and age, disease activity index, metrology index, erythrocyte sedimentation rate and C-reactive protein levels p> 0.05 .Conclusions: As a result of in this study, dry eye was found to be the most common ocular finding in patients with rheumatoid arthritis and ankylosing spondylitis. There was significant association between uveitis and duration of the disease in ankylosing spondylitis patients. However, there were no significant association between indicators of disease activity and dry eye in rheumatoid arthritis patients, and uveitis in ankylosing spondylitis patients

Anahtar Kelimeler

Rheumatoid arthritis, ankylosing spondylitis, ocular findings

Kaynakça

• ) Grassi W, De Angelis R, Lamanna G, Cervini C. The clinical features of rheumatoid arthritis. Eur J Radiol ;27(1):18-24. ) Khurana R, Berney SM. Clinical aspects of rheumatoid arthritis. Pathophysiology 2005;12(3):153
• ) Prete M, Racanelli V, Digiglio L, Vacca A, Dammacco F, Perosa F. Extra-articular manifestations of rheumatoid arthritis: An update. Autoimmun Rev 2011;11(2):123
• ) Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular Manifestations in R h e u m a t o i d A r t h r i t i s . M a e d i c a ( B u c h a r ) ;5(4):286-91. ) Van Der Linden S, Van Der Hejide D, Braun J. Ankylosing spondylitis. In: Harris ED, Budd RC, Frestein GS, Genovese MC, Sergent JS, Ruddy S, Sledge CB, eds. Kelley's textbook of rheumatology. Philadelphia: Elsevier Saunders, 2005:1125-1141.
• ) El Maghraoui A. Extra-articular manifestations of ankylosing spondylitis: prevalence, characteristics and therapeutic implications. Eur J Intern Med ;22(6):554-60. ) Munoz-Fernandez S, Martin-Mola E. Uveitis. Best Pract Res Clin Rheumatol 2006;20(3):487-505.
• ) Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis ;67(7):955-9. ) Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS. The American Rheumatism Association revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31(3):315-24.
• ) Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27(4):361-8.
• ) Prevoo ML, Van 't Hof MA, Kuper HH, Van Leeuwen MA, Van de Putte LB, Van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38(1):44-8.
• ) Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol ;21(12):2286-91.
• ) Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994;21(9):1694-8.
• ) Fujita M, Igarashi T, Kurai T, Sakane M, Yoshino S, Takahashi H. Correlation between dry eye and rheumatoid arthritis activity. Am J Ophthalmol ;140(5):808-13. ) Itty S, Pulido JS, Bakri SJ, Baratz KH, Matteson EL, Hodge DO. Anti-cyclic citrullinated peptide, rheumatoid factor, and ocular symptoms typical of rheumatoid arthritis. Trans Am Ophthalmol Soc 2008;106:75-81.
• ) Kobak S. Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: evaluation of 165 patients. Clin Rheumatol ;30(6):843-7. ) Zlatanovic G, Veselinovic D, Cekić S, Zivkovic M, Dordevic-Jocic J, Zlatanovic M. Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci 2010;10(4):323-7.
• ) Eser F, Garip Y, Bodur H. Extraarticular manifestations in Turkish patients with rheumatoid arthritis: impact of EAMs on the health-related quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning. Rheumatol Int ;32(6):1521-5.
• ) Gouveia EB, Elmann D, Morales MS. Ankylosing spondylitis and uveitis: overview. Rev Bras Reumatol ;52(5):742-56. ) Kim TJ, Kim TH. Clinical spectrum of ankylosing spondylitis in Korea. Joint Bone Spine 2010;77(3):235-40.
• ) Ji SX, Yin XL, Yuan RD, Zheng Z, Huo Y, Zou H. Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients. Int J Ophthalmol ;5(2):164-6. ) Gehlen M, Regis KC, Skare TL. Demographic, clinical, l a b o r a t o r y a n d t r e a t m e n t c h a r a c t e r i s t i c s o f spondyloarthritis patients with and without acute anterior uveitis. Sao Paulo Med J 2012;130(3):141-4.
• ) Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Ophthalmol 2005;50(4):364
• ) Chen CH, Lin KC, Chen HA, Liao HT, Liang TH, Wang HP, Chou CT. Association of acute anterior uveitis with disease activity, functional ability and physical mobility in patients with ankylosing spondylitis: a cross-sectional study of Chinese patients in Taiwan. Clin Rheumatol ;26(6):953