|Year : 1979 | Volume
| Issue : 4 | Page : 22-23
LC Dutta, CK Barua
Gauhati Medical College, Gauhati, India
L C Dutta
Deptt. Of Ophthalmology Gauhati Medical College, Gauhati (Assam)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dutta L C, Barua C K. Rheumatoid iridocyclitis. Indian J Ophthalmol 1979;27:22-3
Uveitis in collagen tissue disorder is comparatively rare except in juvenile rheumatoid arthritis and ankylosing spondylitis which are considered as collagen diseases. Uveitis in rheumatoid arthritis and related joint conditions has been described by various authors. The name rheumatoid iridocyclitis used to describe the anterior uveitis in Rheumatoid group of diseases.
| Material and methods|| |
65 patients attending the eye department of Gauhati Medical College Hospital during the period from June, 1975 to September, 1976 are taken in this study. After the cases were diagnosed as uveitis clinically, they were investigated to find out the probable aetiological cause. Rheumatoid aetiology was labelled when at least three of the following points were present:
(1) Joint pain and/or backache.
(2) Presence of joint deformities.
(3) Elevated E.S.R.
(4) Positive X-ray finding in the joints.
(5) Absence of any other definite aetiology.
In addition to the routine investigations, serum anti-streptolysin (A.S.O.) titre was estimated in 10 patients. A.S.O. titre in aqueous could be done in only two of these patients.
Observations: Out of 65 patients rheumatoid aetiology could be found in 18 patients constituting 27.7%. Out of these 18 patients 14 were males and 4 were females. In 4 patients (22.2%) iridocyclitis was bilateral and in the rest unilateral. Past history of iridocyclitis in the same or the other eye was revealed in only 3 patients (16.6%). Elevated E.S.R. above 20mm was found in 8 cases and in 5 of these 8 cases the E.S.R. was in the range of 80 to 120mm at the end of first hour. Serum anti-streptolysin `O' titre was estimated in 10 patients and in 9 of these it was above 125 T.U. Only in one case it was 50 T.U. Aqueous humour A.S.O. titre was estimated in 2 of these 10 cases and in both of them it was 250 T.U.
| Discussion|| |
The incidence of anterior uveitis in collagen tissue disorder is not so rare as it was thought to be. Available literature shows the incidence to vary from 20-27% (Paul, Stanworth) In our study out of 65 cases, 3 (16.6%) had mild and recurrent type of uveitis and 15 (83.3%) had chronic long standing uveitis.
Uveitis in rheumatoid arthritis is said to be uncommon in elderly patients. - But in our series 77.2% of the patients were of older age group. In 3 children poly-arthritis was associated with band keratopathy and lymphadenopathy; as such these were diagnosed as Still's disease. Smiley reported the incidence of Still's disease to be 11%.
A.S.O. titre estimation of serum/aqueous humor was positive in high titre in 9 out of 10 cases and in all these 9 cases no other aetiological factor could be found except some source of focal sepsis like infected sinus and septic teeth. High level of A.S.O. titer signified streptococcal allergy. In the absence of any other aetiological factor to explain for rheumatoid arthritis, these cases are thought to be due to streptococcal allergy. Though rheumatoid arthritis is a manifestation of collagen tissue disorder it may be possible that streptococal toxin may trigger up the pathology of rheumatoid arthritis and uveal involvement.
| Summary and conclusion|| |
In searching the aetiology of 65 cases of anterior uveitis 27.7% was found to be due to rheumatoid arthritis. From this study the following conclusions can be drawn-
(1) Though -it is said that rheumatoid iridocyclitis is a rare condition, it is seen to be quite common in the present study.
(2) The incidence of Still's disease was found to be 16.5%.
(3) Streptococcal allergy probably has some role in the production of rheumatoid arthritis and rheumatoid iridocyclitis in particular.
| References|| |
Maumenee, A.E., 1956, Arch. Ophthal., 56, 557.
Paul, S.D., 1962, Proceed. A.LO.S., 20, 86.
Smiley, W.K., 1973, Proc. Roy. Soc. Med., 66, 1163.
Stansworth, A., 1957, Brit. J. Ophthal., 41, 412.
Woods, A.C. and Guyton, J.S., 1944, Arch. Ophthal., 31, 469.