They are systemic, that is, they affect all the organs of the body, therefore also the eyes. Vision impairments can also be the anticipation of a diagnosis of rheumatic disease, or they can already occur in the course of one of the more than 200 existing rheumatic diseases and affecting more than 5 million Italians. “Ocular involvement in autoimmune rheumatic diseases is frequent: Behçet’s Syndrome, a rather widespread disease in Japan and East Asia and to a lesser extent in the West where it is a rare disease, is an example and in the most serious cases it can lead also to blindness. There are also other rheumatic diseases that affect vision, affecting both the front and back of the eye and the retina. Ocular involvement can arise within an already evident clinical process, but sometimes it can anticipate the systemic commitment of a rheumatic disease starting as a naïve picture, therefore clinical experience is always of great use to interpret the ocular inflammatory picture without other signs and symptoms of systemic rheumatic disease “, underlines Angelo De Cata, president of the Italian College of Rheumatologists (CReI).
Although ocular inflammatory involvement associated with rheumatological diseases is quite frequent, the subject is still too little talked about. Still, he remarks Carlotta Nannini, rheumatologist at the Santo Stefano Hospital in Prato AUSL Toscana Centro, “the eye, in all its anatomical parts, represents one of the most common targets of rheumatic diseases. They can involve the optic nerve, as in the case of optic neuritis which can appear in giant cell arteritis and vasculitis of the great vessels, or, again, they can cause vascular involvement, compromising the functionality of the blood vessels. for example, they have a more important ocular inflammatory involvement. Uveitis, episcleritis, retinal vasculitis, dry eye and other manifestations that impair vision may occur. “
The interdisciplinary collaboration between specialists is of fundamental importance to take care of rheumatological patients at 360 °. “Most ocular inflammations do not have direct clinical tests: Behçet’s disease, which in 20% of cases begins only with ocular compression, requires the ophthalmologist to know rheumatic diseases well. And not only in this case, given that 40% of uveitis are associated with systemic pathologies of even rheumatological interest, as happens in spondyloarthritis (ankylosing spondyloarthritis, psoriatic arthritis) and in sarcoidosis, to mention two other of the most frequent pathologies with ocular involvement “, he explains Luca Cimino, responsible for the simple interdepartmental structure of Ocular Immunology of the AUSL-IRCSS of Reggio Emilia. “Therefore, it is essential that the ophthalmologist not only knows these diseases well but that there is also a close, active, synergistic and constructive collaboration with the rheumatologist. We have learned from rheumatologists to treat eye inflammations and to manage the therapy well. with cortisone, as well as using so-called steroid-sparing drugs and biologics “.
How are eye inflammations treated? “It varies according to the rheumatic pathology, but generally the first therapeutic approach is with cortisone: it is the drug that acts more quickly, blocking the pathological process and stopping the inflammation that could lead to visual reduction or even loss of vision. However, that with cortisone is a first acute treatment, then, depending on the rheumatic pathology to be treated, biological drugs such as anti-TNF, adalimubab and infliximab are considered, and, more recently, we also have other drugs like anti-interleukin 6 – anti IL6 – which allows good control over the vascular part “, he replies Carlotta Nannini. “Thanks to the advent of imaging techniques in ophthalmology, such as OCT, we can scan all the anatomical layers of the eye and, with the use of laser flare photometry, we can objectively evaluate at what point is the “inflammation and how effective the drug is for that particular patient. Today, we also have devices that gradually release cortisone into the eye. We are awaiting AIFA approval for the use of fluocinolone for the treatment of uveitis.” A single administration of this drug could have an effect lasting three years, “he adds Luca Cimino.
How often are the checks carried out? “Also in this case, a lot depends on the clinical picture of the individual. It may be necessary to have a weekly control in the acute phase, quarterly, half-yearly or yearly, in the chronic phase. “, says Cimino.
There is another aspect that should not be underestimated: rheumatological diseases have an enormous psychological impact and the fear that the eyes may have lasting impairment can aggravate their burden. “Sight allows you to move in space. The thought of losing it or that there may be a deficit that takes away autonomy and reduces the quality of life, is a fear deeply felt by patients. Today, however, we have very effective tools available to avoid the worst. The ocular involvement underlying an undiagnosed rheumatic disease must be recognized as soon as possible in order to begin ad hoc treatments “, concludes Carlotta Nannini.
.