What Is The Role Of The Rheumatologist
Rheumatologist become involved in the care of patients with eye disease when the eye disease is difficult to control. Rheumatologist have experience in the diagnosis of autoimmune and inflammatory diseases. They can further evaluate the patient for systemic conditions that can be associated with eye inflammation. They also have extensive knowledge of the immunosuppressive medications that may be used to treat the disease. They can monitor for potential side effects of the medications being used as well. The role of the rheumatologist is important in the care of patients with eye inflammatory disease so regular follow up is necessary.
The Eyesight Threat Linked To Psoriatic Arthritis
Never heard of uveitis? Its time to learn about the eye condition that, without treatment, can cause permanent damage.
If you have psoriatic arthritis, youre probably familiar with the symptoms that affect your joints. But you should also be on the lookout for eye pain or blurry vision symptoms of a condition known as uveitis.
Uveitis is the inflammation of the uvea, or the middle layer of the eye thats located under the white of the eye. This layer is made up of the iris, the ciliary body , and the choroid .
People with psoriatic arthritis are at a higher risk of developing this inflammation of the eye, says John M. Davis, III, MD, a rheumatologist at the Mayo Clinic in Rochester, Minnesota.
The reasons for this increased risk are uncertain, according to Dr. Davis. But its likely the inflammation that causes joints to flare can also affect some of the tissues in the eye, he says.
People with the gene for the human leukocyte antigen HLA-B27 may have a higher risk of certain autoimmune conditions, including psoriatic arthritis and uveitis, according to the U.S. National Library of Medicine. The presence of HLA-B27 gene causes a gene product that promotes inflammation, says Mandi D. Conway, MD, professor and interim chair of ophthalmology at the University of Arizona College of Medicine-Phoenix.
Eye Concern #: Glaucoma
Caused by increased pressure inside the eye that can damage the optic nerve, glaucoma tends to be a genetic condition that strikes later in lifebut it also can be a side effect of eye inflammation from RA, says Dr. Bhatt. Often, glaucoma patients dont have symptoms until the late stages, when they start having tunnel vision and seeing halos.
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If I Have Inflammatory Arthritis How Can I Protect My Eyesight
Monitor your eyes and vision
Many of the eye conditions associated with arthritis can have drastic and permanent effects on your sight, but catching them early can make a huge difference. Make sure you are attending regular eye tests so that any conditions can be diagnosed and treated as quickly as possible. If you notice any changes to your vision, or dryness, redness, or pain in your eyes, speak to your doctor immediately.
Take your medication
Reducing inflammation across your whole body is key to preventing eye conditions that arise from arthritis. It is important to take any medication you have been prescribed as instructed, even if you start to feel better, to prevent flare-ups and further problems.
If you have any questions or concerns about your medication, talk to your healthcare team. Also check with them before taking any over-the-counter remedies, such as nutritional supplements or painkillers, as these may interfere with your medication.
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Treatment Of Eye Problems Tied To Ra
First, your rheumatologist will treat the RA, which will also help your eye problem. This might start with over-the-counter drugs like nonsteroidal anti-inflammatory drugs , but it could also include other medicines, like steroids. They may also send you to your eye doctor.
If that happens, depending on the type of eye problem you have, you may get eye drops or ointment with steroids to ease inflammation. If what’s going on with your eyes is more severe, your eye doctor may give you oral steroids, and if needed, drugs that power down your immune system, like biologic medicines. You would get these if your eye problem comes from an overactive immune system, the same thing that causes RA.
For dry eyes, ointments to moisten and protect your eyes or drops can help.
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Know The Signs Of Eye Trouble And What To Do About It
Arthritis is a broad category of inflammatory diseases, and rheumatoid arthritis in particular is a systemic inflammatory disease the symptoms can reach every area of your body. So, while RA is well known for attacking joints with pain, swelling and stiffness, it can just as easily bring that inflammation and discomfort to other organs and tissues.
Not every RA sufferer will experience eye changes, but its important to know which eye problems might pop up, and how to recognize them so you can protect your eye health and keep your vision sharp.
Eye Concern #: Retinal Toxicity
Cruel irony: Some of the medications that we use to treat rheumatoid arthritis can potentially cause eye problems, says Dr. Feinberg. One top culprit? Quinolines , which are classified as anti-malaria drugs but are commonly used for RA because they treat inflammation. They can build up in the eye and affect vision or even damage the back of the eye and cause loss of vision, Dr. Feinberg explains, a condition called retinal toxicity.
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Stomach Problems Due To Cervical Spondylosis
Cervical spondylosis is the most widespread cause of symptoms associated with spinal cord impairment in the function of older adults. Vertigo, nerve dysfunction, tremble, vomiting, abdominal irritation, ringing noise in the ears , problems related to vision, and poor memory are other associated symptoms of cervical spondylosis.
Some cases of stomach pain are caused by nerve entrapment in the lateral border of the rectum. This causes pain in the abdominal muscles. Arthritis patients often experience inflammation and irritation in the intestinal tract or the bowels during the onset of the disease. When the bowel is irritated, it causes moderate to severe pain in the stomach or results in diarrhea or digestive complications.
When there is inflammation in your jawbones it can cause severe discomfort and complexity in opening and closing your jaws. Eating and drinking are typical issues of this condition.3,4
What Is Juvenile Idiopathic Arthritis Of The Eyes
Although it might not seem possible, a disease that affects the joints can sometimes also affect the eyes.
Children with juvenile idiopathic arthritis or JIA can develop eye problems either as a result of the disease itself or, rarely, as a side effect of some medicines.
This information will help you learn more about how JIA might affect your child’s eyes.
How the eye works
- The eye functions in the same way as the inner workings of a camera. The front of the eye admits light rays through the cornea, the pupil , and a transparent fluid known as the aqueous humor in the anterior chamber.
- Next, the lens focuses that light through a clear gel-like substance called the vitreous humor, onto the retina. The retina is a thin layer of tissue that makes up the inner lining of the back of the eye.
- The retina works like film in a camera, transforming light into images. It converts the light rays to impulses that travel along the optic nerve to the brain. The brain integrates the images sent from both eyes and interprets them as a single, three-dimensional image, allowing us to perceive depth and distance.
If any of the parts of the eye become damaged, changes in eyesight can occur.
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Inflammation And Irritation Of The Eyes Due To Rheumatoid Arthritis
Inflammation, redness, and irritation of the eyes may occur in people who have rheumatoid arthritis. Certain types of eye inflammation are associated with rheumatoid arthritis.
- Iritis is the inflammation of the iris, or colored part of your eye. Irritation can produce blurred vision, floaters in your sight, or other visual problems.
- Scleritis is inflammation of the sclera, the white outer layer of the eye. You will most likely experience irritation, pain, sensitivity to light, and even visual problems if you develop this.
- Uveitis occurs at the very center of the eye, or the uvea. The symptoms are very similar to the symptoms associated with iritis.
Treatment Of Eye Problems Related To Rheumatoid Arthritis:
Early eye detection is important for your treatment of Rheumatoid arthritis. When the condition of RA is detected and treated early and the inflammation is reduced, you will be less likely to develop eye disorders caused by Rheumatoid arthritis.
Using eye drops, warm compresses, and topical lubricants, you can treat your eye complications. These treatments can help in relieving redness, dryness, and itching. The best eye drops are those drops without preservatives.
For severe cases of inflammations that do not respond to eye drops, you should consult with your doctor. They would recommend you a topical steroid or immunosuppressive medications. They are basically applied twice a day for treating the underlying inflammation.
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Making The Most Of Your Eyesight
Did you know that from the age of 40 our eyes change rapidly? And by the age of 65, we will need three times more light to see than we did at 20?
As we grow older, our eyes take longer to adjust to sudden changes in light and dark. They are more sensitive to glare and are less able to judge distance and depth. This, in turn, can affect your ability to see the edges of steps, stairs, footpaths and kerbs.
Your eyes not only allow you to see obstacles and judge steps, they also play an important role in helping you to keep your balance. Gradual changes in eyesight, which we may not actually notice, can increase a persons risk of having a fall.
Bifocal, trifocal or multifocal glasses can also increase a persons chance of falling, as the changes in the lens can make it more difficult to judge distances and see objects on the ground. Other eye conditions, such as macular degenerationor glaucoma, can also impair a persons vision.
So, what can you do to maximise your eyesight and reduce the risk of fall?
Have your eyesight and glasses checked by an optometrist at least once every two years and yearly by a doctor.
If you notice changes in your eyesight, make an appointment with your doctor or optometrist. Early detection of eye problems can stop them from becoming worse.
Keep your glasses clean and always wear the correct glasses reading glasses for reading and distance glasses for driving or walking around.
How Those With Arthritis Can Help Protect Their Eyes
Its crucial for patients managing their arthritis to stay on top of their eye health. At Florida Eye Specialists, our physicians provide comprehensive eye health exams that check for symptoms of the conditions associated with arthritis, and help you treat problems before they do lasting damage. Contact us today to schedule an appointment and keep the effects of arthritis at bay.
- Tags: arthritis, Cataracts, Dry Eye, dry eyes, Eye health, florida eye specialists, Glaucoma, Vision Problems
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What Is Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune and inflammatory disease. This means that your immune system will attack healthy cells in your body by mistake and cause painful inflammation. Rheumatoid arthritis mainly affects the tissue of your joints, but can also cause medical problems with your heart, lungs, nerves, eyes, and skin.
How Psoriatic Arthritis Affects Your Eyes
Both psoriasis and psoriatic arthritis are autoimmune diseases. That means they cause your body to attack itself by mistake. This can trigger inflammation in certain parts of the body, including your eyes.
If your eyes are irritated and you have psoriasis, you may have uveitis. That’s a term for any inflammation inside your eye. It can lead to swelling and damaged eye tissue. Uveitis may affect one or both eyes. Symptoms include:
Your eye doctor can treat pinkeye.
Glaucoma. This is a group of conditions that damage your optic nerve. It often starts with inflammation that causes a buildup of pressure in your eye. Symptoms include:
You may not have any of these if the disease is in its early stages. That’s why regular eye exams are important. Your eye doctor can catch it even if yoâre not showing symptoms. Glaucoma can also be a side effect of taking corticosteroids for psoriatic arthritis. Talk to you doctor about how to lower this risk.
Cataracts. That âs when inflammation turns the clear lens of your eye cloudy. Symptoms can include:
- Trouble seeing at night
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What Eye Problems Might Affect Children With Juvenile Idiopathic Arthritis
Uveitis is the most common eye problem that can develop in children with JIA. Uveitis is an inflammation of inner parts of the eye. The uvea consists of the iris , the ciliary body and the choroid .
Uveitis might also be known as iritis or iridocyclitis, depending on which part of the eye is affected by inflammation.
If the inflammation is not detected and treated early, scarring and vision problems can occur. Glaucoma, cataracts and permanent visual damage are all complications that could result from severe uveitis.
Uveitis can occur up to one year before, at the same time as, or up to 15 years after JIA is diagnosed. It can also occur even when JIA is in remission .
The severity of the child’s joint disease does not determine how serious the uveitis might be. However, eye problems are more common in children with oligoarthritis . Eye problems are also more likely if your child has a positive blood test for antinuclear antibodies . They are most likely to occur in female toddlers.
How Do I Know If Rheumatoid Arthritis Is Causing My Dry Eye
Consult with your optometrist or ophthalmologist and receive an eye examination focusing on eye disease diagnosis and management. If you know you have rheumatoid arthritis and begin experiencing dry eye disease, your arthritis is most likely the cause of your condition. This is not always the case though,but it is important to consult with an eye doctor first before seeking treatment options.
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How Is Uveitis Treated
Treatment of uveitis is critical to prevent long-term damage.
If you let inflammation persist in the eye, its going to lead to all sorts of problems, says Dr. Werner. You can get glaucoma from the inflammation and have permanent loss of vision from that. You can get a type of scarring where the iris, the colored portion of the eye, sticks to the lens of the eye, and that can also lead to decreased vision and further problems.
The mainstay of uveitis treatment is steroids to stop the inflammation, says Dr. Patel. Treatment will depend on the part of the eye where the inflammation is, how severe it is, and what else is going on in the body, she says.
Typically, doctors will start with steroid eye drops they may be prescribed for two to three weeks and then tapered off as symptoms start to improve. However, Dr. Werner notes, if the uveitis symptoms return as the drops are tapered, then you have to start the medication again.
For more serious cases of uveitis or those that arent responding well to the eye drops, doctors may recommend steroid injections into the eye or oral steroid pills.
You may also be prescribed eye drops to dilate your pupil and relieve the pain thats accompanying the uveitis.
The goal of uveitis treatment is to make the disease inactive with the least amount of medication needed, says Dr. Patel.
Its very important to follow your doctors instructions for treating your uveitis to avoid complications.
Eye Concern #: A Red Painful Eye From Scleritis
Another type of eye inflammation, scleritis is more concerning than episcleritis because the inflammation is more severe and involves the sclera, the next layer down in the white of the eye. People with RA, as well as other inflammatory or autoimmune diseases, are at increased risk for scleritis. Symptoms include redness and pain, and it can lead to blindness, says Dr. Bhatt. The eye may also have a bluish tinge in the later stage. Patients with scleritis usually make a doc appointment right away because the pain, while not severe or stabbing, is difficult to tolerate.
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How Is Uveitis Diagnosed
The majority of the time, uveitis is easy to diagnose, says Dr. Patel.
If a patient comes in complaining of pain, redness, and light sensitivity, the eye doctor will likely suspect it could be uveitis. They will use the biomicroscope where you put your chin in that instrument and your doctor can look at the front and back of the eye, says Dr. Werner to look for evidence of inflammatory cells floating in your eye.
Then your doctor will ask questions about your medical history and other symptoms to try to assess whats causing the uveitis.
The rule of thumb is, if an adult comes in, you take a history do you have back pain, you look at their joints, their hands, do you have any arthritis? says Dr. Werner. If they have none, he says, you typically just treat the uveitis symptoms . Every adult is entitled to one episode of uveitis before you do a workup, he adds.
But if you have anything in your medical history that suggests you could have an autoimmune disease or an infection , your eye doctor may order more testing or refer you to another specialist.
According to the AAO, additional testing could include:
- Physical exam