Peripheral ulcerative keratitis in the setting of rheumatoid arthritis: Treatment with immunosuppressive therapy*

https://doi.org/10.1016/S0049-0172(95)80019-0Get rights and content

Abstract

Peripheral ulcerative keratitis (PUK) is a rare but serious inflammatory eyecondition that can complicate rheumatoid arthritis. PUK can be a warning sign of impending vasculitis, and cytotoxic therapy may be necessary to induce remission. We have encountered three patients with PUK in the past year. Two patients had long-standing quiescent rheumatoid arthritis who developed photophobia. Diagnosis was made by slit lamp examination. Treatment with local cyclophosphamide and prednisone resulted in prompt remission of the ulcer within 8 weeks. Cytotoxic therapy was discontinued altogether within 6 months. The third patient was also treated successfully with oral steroids and azathioprine. In all patients, sicca was noted. None of them had any evidence of systemic vasculitis. PUK, when recognized early and treated aggressively, can result in remission of the ulcer and in the prevention of vasculitis. Keratoconjunctivitis sicca can accompany PUK independent of the activity of rheumatoid arthritis.

References (28)

  • JohnS.I. et al.

    Corneal autoimmunity in patients with peripheral ulcerative keratitis in association with rheumatoid arthritis and Wegener's granulomatosis

    Eye

    (1992)
  • WilsonF.M. et al.

    Treatment of peripheral corneal ulcers by limbal conjunctivectomy

    Br J Ophthalmol

    (1976)
  • BerenbaumM.C. et al.

    Dose-response relationships for agents inhibiting the immune response

    Immunology

    (1964)
  • AskenaseP.W. et al.

    Augmentation of delayed-type hypersensitivity of doses of cyclophosphamide which do not effect antibody response

    J Exp Med

    (1975)
  • Cited by (25)

    • Peripheral ulcerative keratitis

      2021, Survey of Ophthalmology
      Citation Excerpt :

      Other side effects of systemic steroids, e.g., hypertension, hyperglycemia, hirsutism, etc., must be watched for. The presence of PUK may herald an impending life-threatening vasculitis, and immunosuppressive agents are often required to induce disease remission in cases with underlying autoimmune disorders.75 These agents reduce disease mortality and ocular morbidity47,52,129 and are usually started along with high dose systemic steroid.

    • Vasculitic peripheral ulcerative keratitis

      1999, Survey of Ophthalmology
    View all citing articles on Scopus
    *

    Acknowledgment; We are indebted to Robert Marsh for hisvaluable suggestions on review of this manuscript.

    View full text