Contributor: Gordon K. Klintworth
Rheumatoid arthritis is a chronic systemic autoimmune disease that affects the joints and other tissues. The condition may occur at any age, but the onset is usually during the third or fourth decade of life. Polyarthritis is a prominent feature. Many of the lesions, including those in the sclera are characterized by the rheumatoid nodule. The cornea is frequently affected and the corneal melting syndrome occurs especially in the peripheral cornea. Corneal stromal tissue is often lost without an associated inflammatory infiltrate. Sometimes a full thickness corneal perforation develops. Other ocular manifestations include: keratoconjunctivitis sicca, keratitis (incuding sclerosing keratitis [keratitis - sclerosing]), peripheral corneal furrows, scleritis (which may be necrotizing [scleritis - necrotizing]), episcleritis and ocular motility disturbances. Many lesions, including those in the sclera are characterized by necrosis surrounded by a zone of chronic inflammation containing macrophages, lymphocytes, epithelioid cells and multincleated giant cells. The retina and choroid is rarely involved in rheumatoid arthritis. Therapy with chloroquine or hydroxychloroquine can cause toxicity [chloroquine toxicity, hydroxychloroquine toxicity].