Prevalence and factors associated with ocular manifestations of Rheumatoid Arthritis among patients attending Mulago National Referral Hospital.

Abstract

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with numerous extra-articular organ involvement. Ocular manifestations associated with RA include episcleritis, scleritis, conjunctivitis, peripheral ulcerative keratitis, dry eye syndrome, uveitis, cataract and retinal vasculitis. These may be caused by the disease activity itself or drug used to treat this condition. There is no documented study in Uganda on ocular manifestations of RA. Aim: To determine the prevalence and factors associated with ocular manifestations of rheumatoid arthritis among patients attending Mulago national referral hospital. Methods and materials: The study was a hospital based cross-sectional study of 105 RA patients seen at the rheumatology medical outpatient clinic in Mulago national referral hospital, from July 2021 to September 2021. Participants who met the inclusion criteria were recruited consecutively until the required sample size was reached. Informed consent was obtained from all the study participants. Details of findings from the history and clinical examinations were recorded using a questionnaire and data was entered using Epi data and analyzed using STATA version 15.0. Results: A total of 105 patients with RA were recruited. Their mean age was 45.5 (SD±15.8) years, ages ranging 18-82 years. Majority (92%, n=97) of study participants were female. The prevalence of ocular manifestations in RA was (50.7%, n=53). Dry eye syndrome was the most common ocular manifestation (54.7%, n=29) followed by cataract (13.2% n=7). Other ocular manifestations included episcleritis (5.7%, n=3), raised IOP (3.8%, n=2), and scleritis (1.9%, n=1). There was statistically significant relationship between ocular manifestations and RA patients in age group of 36-55 years (aPR 1.56 p value=0.015), duration of RA of more than 5 years (aPR 1.81, p value=0.001), RA with history of both DM and HTN (aPR 1.87, p value=0.014), and use of hydroxychloroquine for more than 5 years (aPR 1.77, p value=0.041). Conclusion and recommendations: The prevalence of ocular manifestations in RA was high. For early detection of ocular manifestations, ocular examination should be done on all patients at time of RA diagnosis with more frequent examination on RA patients aged 36-55 years, those with disease duration for more than 5 years, those using hydroxychloroquine and RA with history of both DM and HTN.