Background Many inflammatory rheumatic conditions are associated with ocular involvement. The actual prevalence of these complications is not fully known.
Objectives This meta-analysis was performed to systematically investigate the prevalence of ocular involvement in inflammatory rheumatic diseases in order to determine the frequency and type of ocular involvement.
Methods Medline, Web of Science and Cochrane databases were searched up to July 8, 2014, to identify full text publications related to inflammatory rheumatic diseases and associated ocular conditions. Disease terms included; juvenile arthritis (JIA), rheumatoid arthritis (RA), Sjogren's syndrome, Still's disease, systemic lupus erythematosus (SLE), connective tissue disease, spondyloarthropathy, and ankylosing spondylitis (AS). For eye involvement terms were; conjunctivitis, keratoconjunctivitis sicca, xeropthalmia, uveitis, eye hemorrhage, optic neuritis, papilledema, orbital disease, retinal artery/vein occlusion, macular edema, retinitis, chorioretinitis, scleritis, iridocyclitits, choroid hemorrhage, blindness and amaurosis fugax. Data regarding the rates of various ocular complications were extracted. Random effects models pooled rates to estimate the frequency of each complication in the included inflammatory rheumatic diseases.
Results Most of the 7124 studies were excluded, leaving 263 for full review. There were 13 AS cohort studies, 30 Behcet's disease (BD), 31 JIA, 12 PsA, 11 RA and 165 others. Pooled prevalence for commonly reported ocular manifestation were uveitis rates of: 22% (95% CI: 16-24%) in AS, Behcet's 55% (41-68%), JIA [oligoarthritis 36% (20-51%), polyarticular 13% (8-19%) systemic onset 3% (0-7%)], pediatric Behcet's 33% (0-74%), and PsA 15% (5-24%) for anterior uveitis and 0.2% for posterior uveitis. In RA, keratoconjunctivitis sicca occurred in 16% (8-25%), sicca symptoms in 31% (21-42%), marginal ulcerative keratitis in 1-3%, episcleritis in 1-2% and retinal vasculitis in 0.2%. In SLE 29% of patients had dry eyes. There may have been publication bias (over reporting due to selection bias of cohorts enriched for ocular complications such as patients from university clinics where complications could be higher, and several estimates had herterogeneity. Data were lacking on confounding variables (such as screening programs and treatment).
Conclusions Extra-articular manifestations of inflammatory rheumatic diseases frequently complicate the ocular health of afflicted individuals. Although the rates vary, an awareness of potential complications can aid in early identification and treatment of these rheumatic complications.
Disclosure of Interest None declared