ROMATİZMAL HASTALIKLARDA GÖZ TUTULUMU

Year 2015, Volume: 5 Issue: 2, 51 - 55, 01.06.2015

Kadir Kırboğa , Mehmet Uçar Ümit Sarp Mustafa Kemal Arıcı

Abstract

Romatizmal hastalıklar kas iskelet sistemi ile birlikte farklı organ ve sistem tutulumuna se- bep olabilmektedir. Hastaların bir kısmı kas iskelet semptomlarından önce akciğer, böbrek, göz gibi diğer organ ya da sistem tutulumlarına ait şikayetler ile kliniklere başvurabilirler. Göz tutulumu, hastalığın ilk belirtisi olabileceği gibi hastalığın seyrinde de gelişebilir. Ro- matizmal hastalıklar gözün tüm tabakalarını tutabilir. Basit bir konjonktivit tablosundan görmenin kaybına kadar geniş bir yelpazede göz tutulumu olmaktadır. Bu hastalıklarda üveit, keratit, episklerit, sklerit ve anterior iskemik optik nöropati gibi oküler inflamasyon bulguları görülmektedir. Hastalığın uygun tedavisi ile bu tutulumların önüne geçilebilmek- tedir. Ancak tedavide kullanılan ilaçların oküler ve sistemik toksik etkileri bulunmaktadır. Bu nedenle tanı anından itibaren tedavi ve takip sürecinde, romatolog ve göz hekimlerinin koordineli çalışması gereklidir.
Anahtar kelimeler: Romatizmal hastalıklar, Üveit, Sklerit

ABSTRACT
Rheumatic diseases may lead to involvement of different organ systems other than the musculoskeletal system . Some patients may apply to the clinics with the complaints about the other systems like lung, kidney and eye, even before the musculoskeletal symptoms have appeared. Eye involvement may be the first symptom or it could develop in the course of the disease. Rheumatic diseases may involve all layers of the eye and result in a broad spectrum of vision disorders, from a simple conjunctivitis to complete loss of sight. Patients may have ocular inflammatory findings such as uveitis, scleritis or ceratitis. Both the rheumatic diseases and the drugs used for ocular involvement have ocular or systemic adverse effects. The eye involvement of the disease can be avoided with proper treatment . However, the drugs used in the treatment have ocular and systemic toxic effects by themselves . Therefore, the rheumatologists and ophtalmalogists should work in coordination both on treatment and follow-up process right after the moment of diagnosis.

Keywords: Rheumatic diseases, Uveitis, Scleritis

Keywords

Romatizmal hastalıklar, Üveit, Sklerit

References

• Fujita M, Igarashi T, Kurai T, Sakane M, Yoshino S, Takahashi H. Correlation between dry eye and rheumatoid arthritis activity. Am J Ophthalmol. 2005;140(5):808–813
• Liu KC1, Huynh K, Grubbs J Jr, Davis RM. Autoimmunity in the pathogenesis and treatment of keratoconjunctivitis sicca. Curr Allergy Asthma Rep. 2014;14(1):403.
• Artifoni M, Rothschild PR, Brézin A, Guillevin L, Puéchal X. Ocular inflammatory diseases associated with rheumatoid arthritis. Nat Rev Rheumatol. 2014;10(2):108-16.
• Kanski JJ: Clinical Ophthalmology. Oxford, ButterworthHeinemann,1997: 116-123.
• Squirrell DM, Winfield J, Amos RS. Peripheral ulcerative keratitis corneal melt and rheumatoid arthritis: a case series. Rheumatology. 1999; 38: (12): 1245.33.
• Peric S, Cerovski B, Peric P. Anterior ischaemic opticneuropathy in patient with rheumatoid arthritis-case report. Coll Antropol. 2001;25(2):67-70.
• Wenngren BI, Toolanen G, Hildingsson C. Oculomotor dysfunction in rheumatoid patients with upper cervical dislocation. Acta Otolaryngol. 1998;118(5):609-12.
• Panfilio CB, Hernandez-Cossio O, Hernandez-Fustes OJ. Orbital myositis and rheumatoid arthritis: case report. Arq Neuropsiquiatr. 2000;58(1):174-7.
• Mesut Coşkun, Ali Akal. Osteoporoz ve romatizmal hastalıklarda göz bulguları. Dicle Tıp Derg. 2009;36(4), 329- 3
• Vitale AT1, Graham E, de Boer JH. Juvenile idiopathic arthritis-associated uveitis: clinical features and complications, risk factors for severe course, and visual outcome. Ocul Immunol Inflamm. 2013;21(6):478-85.
• Tugal Tutkun I. Çocukluk çağı romatizmal hastalıklarında göz tutulumu. Türkiye Klinikleri Pediatrik Bilimler Pediatrik Romatoloji Özel Sayısı. 2008;4(3): 139-143.
• Qian Y, Acharya NR. Juvenile idiopathic arthritis- associated uveitis. Curr Opin Ophthalmol. 2010;21(6): 468-4
• Ali A, Samson CM. Seronegative spondyloarthropathies and the eye. Curr Opin Ophthalmol. 2007 Nov;18(6):476-80.
• Busch M, Bauer D, Hennig M, Wasmuth S, Thanos S, Heiligenhaus A. Effects of systemic and intravitreal TNF-α inhibition in experimental autoimmune uveoretinitis. Invest Ophthalmol Vis Sci. 2013;54(1):39-46.
• Gouveia EB1, Elmann D, Morales MS. Ankylosing spondylitis and uveitis: overview. Rev Bras Reumatol. 2012;52(5):742-56.
• Felekis T, Katsanos K, Kitsanou M, Trakos N, Theopistos V, Christodoulou D et al. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: a prospective single-center study. Inflamm Bowel Dis. 2009;15(1):29-34.
• Orchard TR, Chua CN, Ahmad T, Cheng H, Welsh KI, Jewell DP. Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes. Gastroenterology. 2002;123(3):714-718.
• Davies JB, Rao PK. Ocular manifestations of systemic lupus erythematosus. Current Opinion in Ophthalmol. 2008;19(6):512–518.
• Ushiyama O, Ushiyama K, Koarada S, Tada Y, Suzuki N, Ohta A et al. Retinal disease in patients with systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2000;59(9):705–708.
• Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood.2003;101(5):1827–1832
• Gomes Bde A, Santhiago MR, Magalhaes P, Kara-Junior N, Azevedo MN, Moraes HV Jr. Ocular findings in patients with systemic sclerosis. Clinics. 2011;66(3):379–385.
• Tugal Tutkun I, Onal S, Altan-Yaycioglu R, Huseyin Altunbas H, Urgancioglu M. Uveitis in Behçet disease: an analysis of 880 patients. American Journal of Ophthalmology. 2004;138(3):373–380.
• Davatchi F, Shahram F, Shams H, Nadji A, Chams- Davatchi C, Akhlaghi M et al. Gender influence on ocular manifestations and their outcome in Behcet’s Disease. A long-term follow-up of up to 20 years. Clinical Rheumatology 2011;30(4):541–547.
• Maldini C, Lavalley MP, Cheminant M, de menthon M, Mahr A. Relationships of HLA-B51 or B5 genotype with Behçet’s disease clinical characteristics: systematic review and meta-analyses of observational studies. Rheumatology. 2012;51(5):887–900.
• Yalçindag FN, Can E, Ozdemir O. Intravenous methylprednisolone pulse therapy for acuteposterior segment uveitis attacks in Behçet’s disease. Ann Ophthalmol. 2007; 39(3):194-197.
• Toker E, Kazokoglu H, Acar N. High dose intravenoussteroid therapy for severe posterior segment uveitis in Behçet’s disease. Br J Ophthalmol. 2002;86(5):521-523.
• Yazici H, Pazarli H, Barnes CG, et al. A controlled trial of azathioprine in Behçet’s syndrome. N Engl J Med. 1990;322(5):281-285.
• Akman-Demir G, Ayranci O, Kurtuncu M, et al. Cyclosporine for Behçet’s uveitis: is it associated with an increased risk of neurological involvement? Clin Exp Rheumatol. 2008;26(50):84-S90.