ASSOCIATION OF RHEUMATOID ARTHRITIS WITH GLAUCOMA

 

Rheumatoid arthritis (RA) is a progressive, inflammatory, autoimmune disease. Several factors, including autoantibodies, immune complexes, T cell-mediated antigen-specific responses, and T cell-independent cytokine networks, are involved in the pathogenesis of RA.

There is evidence of immunological mechanisms in the development and progression of primary open-angle glaucoma (POAG). Autoantibodies and CD4+ T cells involved in the pathogenesis of RA are also observed in patients with POAG. Similarly, there is enhanced expression of Heat-Shock protein (HSP) in glaucoma patients. Another indirect evidence comes from the use of etanercept, a tumor necrosis factor–α inhibitor used to control RA progression, reduced retinal ganglion cell (RGC) loss by approximately 50% in a rat glaucoma model.

However, there is limited evidence connecting RA, the most common autoimmune disease, with the risk of developing POAG.

Kim and colleagues conducted a nationwide propensity-matched cohort study using data from the Korean National Health Insurance Service-Senior cohort from 2002 to 2013. Data analysis was performed from November 2020 to July 2021.

A total of 2049 patients with incident seropositive RA and 8196 time-dependent, propensity score–matched, risk-set controls were included.

The cumulative incidence of POAG was higher in the RA cohort than in the matched cohort during the entire follow-up period. The 2-year cumulative incidence risk of POAG was 2.36% in the RA cohort and 1.28% in the matched-control cohort; the 4-year cumulative incidence risk was 4.29% in the RA cohort and 2.64% in the matched control cohort.

POAG developed in 86 of 2049 patients with RA and 254 of 8196 matched controls.

In the RA cohort, the incidence rate of POAG was 981.8 cases per 100 000 person years (95% CI, 794.3-1213.7 cases per 100 000 person years), whereas in the matched controls, the incidence rate was 679.5 cases per 100 000 person years (95% CI, 600.8- 768.3 cases per 100 000 person years).

Patients with RA were more likely to develop POAG than the matched controls (hazard ratio [HR], 1.44; 95% CI, 1.13-1.84). Increased POAG risk in the RA cohort was predominantly observed 2 years into the follow-up period (HR, 1.83; 95% CI, 1.28-2.61) and in those aged 75 years or older (HR, 2.12; 95% CI, 1.34-3.35).

These findings suggest that RA is associated with a higher risk of developing POAG, especially within 2 years after diagnosis or among patients aged 75 years or older.

When considered collectively, it is reasonable to suspect that RA and POAG share common pathogenic pathways, including autoimmune components.

REFERENCE:

Kim SH, Jeong SH, Kim H, Park EC, Jang SY. Development of Open-Angle Glaucoma in Adults With Seropositive Rheumatoid Arthritis in Korea. JAMA Netw Open. 2022 Mar 1;5(3):e223345. doi: 10.1001/jamanetworkopen.2022.3345.