title: Peripheral corneal ulceration associated with rheumatoid arthritis.
abstract: METHODS
  Female, 60 FINAL DIAGNOSIS: Corneal ulceration Symptoms: Blurred vision Medication: Abatacept Clinical Procedure: - Specialty: Ophthalmology.
  
  
  OBJECTIVE
  Management of emergency care.
  
  
  BACKGROUND
  To report a case of a patient with rheumatoid arthritis (RA) and associated peripheral corneal ulceration.
  
  
  METHODS
  A 60-year-old woman with RA diagnosed 15 years ago, under immunosuppressive therapy (IV abatacept 250 mg/month), demonstrated blurring of vision in her RE (right eye). Visual acuity was 6/10 in the RE and 10/10 in the LE. Slit lamp examination revealed a paracentral superior corneal melt in the RE. Anterior chamber reaction was 2+. Laboratory investigations revealed positive anti-Ro and anti-La, anti-Extractable Nuclear Antigens (anti-ENA, ELISA), while anti-Sm, anti-Rnp, anti-Jo1 and anti-Scl70 were found negative. IgG and IgA serum immunoglobulins were found elevated, but IgE and IgM were within normal levels. Further evaluation for the underlying disease revealed highly elevated rheumatoid factor and C-reactive protein. The patient, who had been receiving anti-TNF during the last 6 months, underwent treatment with topical tobramycin and lubricants and oral prednisone 60 mg/day with tapering doses, to which methotrexate p.os. 15 mg/week was added. The condition improved within a few days after the initiation of prednisone treatment. Re-epithelization occurred 1 week after the onset of the immunosuppressive treatment. Only punctate fluorescein dye uptake was detected in the margins of the lesion.
  
  
  CONCLUSIONS
  The effective control of the underlying disease and early diagnosis of the dry eye syndrome in RA patients may prevent serious corneal complications such as corneal ulceration. The initiation of treatment with steroids and immunosuppresants was found to halt the progression of keratolysis, and assisted re-epithelization.
authors.affiliation: Laboratory of Experimental Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Karampatakis
authors.forename: Vasileios
authors.initials: V
authors.lastname: Konidaris
authors.forename: Maria
authors.initials: M
authors.lastname: Michailidou
authors.forename: Antonios
authors.initials: A
authors.lastname: Gerofotis
authors.forename: Michail
authors.initials: M
authors.lastname: Daniilidis
keywords: ant-TNF; anti-ENA; immunosuppressive therapy; keratolysis; peripheral ulceration; rheumatoid arthritis