**2.1. Rheumatoid arthritis**

Rheumatoid arthritis is an autoimmune connective tissue disease that manifests itself mostly with symmetrical swelling of the joints (particularly of the hands) - and with morning stiff‐ ness. The incidence of RA in the world is estimated at about 0.33 -1.5% of the total popula‐ tion [1,2,3,4,5,6]. The diagnosis of RA is based on the current 2010 ACR / EULAR criteria. The diagnosis of RA is definite when the summary point record for all criteria (A + B + C + D) reaches ≥ 6 out of 10. (Table 2) [7].



RF – Rheumatoid Factor, ACPA – Anti-Citrullinated Protein Antibodies, CRP – C-Reactive Protein, ESR – Erythrocyte Sedimentation Rate

**Table 2.** ACR/EULAR 2010 classification criteria for rheumatoid arthritis

**Systemic vasculitis** Polyarteritis nodosa

**Table 1.** Rheumatic diseases with changes occurring in the organ of sight.

tion of the cartilage and systemic vasculitis are observed.

**changes in the organ of sight occur**

**2.1. Rheumatoid arthritis**

214 Common Eye Infections

D) reaches ≥ 6 out of 10. (Table 2) [7].

**A. Joint involvement** 1 large joint

Churg-Strauss syndrome Wegener's granulomatosis

Behçet's disease Takayasu's disease Giant cell arteritis Cogan syndrome

**2. Characteristics of rheumatic diseases, in which the most frequent**

The rheumatoid arthritis (RA) and spondyloarthropathies (SpA) are the most common in‐ flammatory rheumatic diseases. Significantly less frequently uvenile idiopathic arthritis (JIA), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and other less frequent connective tissue diseases as scleroderma, dermato-and polymiositis, recurrent inflamma‐

Rheumatoid arthritis is an autoimmune connective tissue disease that manifests itself mostly with symmetrical swelling of the joints (particularly of the hands) - and with morning stiff‐ ness. The incidence of RA in the world is estimated at about 0.33 -1.5% of the total popula‐ tion [1,2,3,4,5,6]. The diagnosis of RA is based on the current 2010 ACR / EULAR criteria. The diagnosis of RA is definite when the summary point record for all criteria (A + B + C +

1-3 small joints (with or without involvement of large

0 2 3

4 - 10 small joints (with or without involvement of

Positive results in the presence of low-titer RF and

Positive results in the presence of high titers of RF

"/ 10 joints (at least 1 small joint affected)

2-10 large joints

joints )

joints )

ACPA

and ACPA

**B. serological tests (at least one required)** Negative results for the presence of RF and ACPA

Approximately 40% of patients with RA present not only joint inflammation but also clinical symptoms resulting from other organ involvement [8].

Frequently, in as many as about 30% of patients with rheumatoid, rheumatoid nodules oc‐ cur [9]. The changes in the lungs, such as pleural involvement, take place in approximately 50% of patients, but only in 10% of cases are identified [10]. Similarly frequently autopsy re‐ veals changes in the heart.

In echocardiography pericardial effusion is revealed in 31% of patients [11]. 1 - 5% of patients with RA are diagnosed with vasculitis, while autopsy studies detect these changes in 15-31% of patients [12,13]. Changes in the eyes in the course of RA are observed in approximately 25% of patients [14, 15]. The treatment of RA is based on disease-modifying drugs (DMARDs) such as methotrexate, sulfasalazine. leflunomide, cyclosporine, cyclophospamide, hydroxychloro‐ quine or chloroquine and gold salts. Furthermore, patients often have glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) administered orally or locally (intra-articularly). In the contemporary rheumatology in case of ineffectivness of the traditional DMARDs thera‐ py second line treatment is implemented - based on biological agents. These include TNFalpha (tumor necrosis factor) inhibitors such as adalimumab, certolizumab pegol, etanercept, golimumab, infliximab as well as drugs with other mechanism of action such as abatacept (anti-CTL-4), rituximab (anti-CD 20) and tocilizumab (anti-IL-6) [16].

**Figure 1.** Scleromalacia perforans in patient with long-term RA (photo by D. Kopacz).

**Figure 2.** Scleromalacia perforans in patient with long-term RA (photo by D. Kopacz).

### **2.2. Spondyloarthropathies**

Spondyloarthropathies (SpA) are a group of diseases are characterized by similar clinical symptoms and genetic predispositions.

**Table 3.** ASAS classification criteria for axial spondyloarthropathy

Spondyloarthropathies can be divided into 2 groups according to the predominant symp‐ toms. The domination of symptoms suggestive of spinal involvement, such as inflammatory back pain (IBP) - i.e. pain escalating at night, decreasing after exercise, not alleviated by the period of rest - defines axial spondyloarthropathy. In patients with prevalence to enthesitis and peripheral arthritis, the peripheral sopndyloarthropathy is diagnosed. ASAS Group (Ankylosing spondylitis In Assessment) has developed diagnostic criteria common to these diseases (Table 3.4) [17, 18].


**Table 4.** ASAS classification criteria for peripheral spondyloarthropathy

**Figure 2.** Scleromalacia perforans in patient with long-term RA (photo by D. Kopacz).

Spondyloarthropathies (SpA) are a group of diseases are characterized by similar clinical

**2.2. Spondyloarthropathies**

216 Common Eye Infections

symptoms and genetic predispositions.

**Table 3.** ASAS classification criteria for axial spondyloarthropathy

There separate classification criteria for particular spondyloarthropathies such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactinve arthritis (ReA), arthritis in course of ul‐ cerative colitis and Leśniowski- Crohn's disease are also established.

Spondyloarthropathies incidence is similar to that of RA and ranges from 0.15 to 1.8% of the general population [19,20,21].

The uveitis affects approximately 0.5% of patients with spondyloarthropathies, and frequen‐ cy of its occurence varies depending on the type of spondyloarthropathies. In AS uveitis oc‐ curs in 0.8% of patients, while in about 2.3% of patients with the PsA [22]. Ocular changes in SpA related to non-specific inflammatory bowel disease (ulcerative colitis, Leśniowski Crohn's disease) occur in up to 4-12% of patients [23,24].

Conjunctivitis occurs in 33-100% of patients with reactive arthritis [25] and 20 to 33% of pa‐ tients with PsA [26].

The treatment of spondyloarthropathies is based on non-steroidal anti-inflammatory drugs, disease-modifying drugs such as methotrexate, leflunomide, sulfasalazine, cyclosporyna and biological agents from the group of anti-TNF-alpha. The glucocorticoids are also used in intraarticular injections [27,28].
