OCULAR PAIN AS A MARKER OF SYSTEMIC INFLAMMATION IN RHEUMATOID ARTHRITIS
R. Usatii1, E. Russu2, E. Bendelic3, A. Corduneanu3, O. Tagadiuc3, L. Groppa3 | 1Timofei Mosneaga Republican Clinical Hospital, Chisinau, Republic of Moldova; 2Timofei Mosneaga Republican Clinical Hospital, Chisinau, Republic of Moldova; Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova; 3Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
Abstract
Background and Aims. Ocular involvement in rheumatoid arthritis (RA) reflects systemic immune activation and may contribute to pain burden beyond articular symptoms. This study aimed to evaluate the relationship between ocular manifestations and pain expression in RA.
Methods. A cross-sectional study included 54 patients with RA. Ophthalmologic evaluation identified corneoscleral involvement, including keratoconjunctivitis sicca and scleritis. Pain intensity was assessed using the visual analog scale. Clinical and biological data included disease duration, Disease Activity Score in 28 joints (DAS28), C-reactive protein (CRP), and autoantibody status.
Results. Ocular involvement was present in 35.2% of patients. These patients had significantly higher pain scores compared to those without ocular manifestations (6.6±1.1 vs 5.2±1.3; p=0.001). Disease activity was significantly higher in the ocular group (DAS28: 5.4±0.8 vs 4.2±0.9; p<0.001), indicating a link between systemic inflammation and ocular pain. CRP levels were also elevated (12.1±5.3 vs 7.4±4.6 mg/L; p=0.003) and correlated with pain intensity (r=0.33; p=0.01). Patients with scleritis exhibited the highest pain burden (VAS 7.1±0.9), compared to keratoconjunctivitis sicca (6.2±1.0; p=0.02). Multivariate analysis identified CRP (β=0.28; p=0.004) and DAS28 (β=0.35; p=0.001) as independent predictors of pain (R2=0.39).
Conclusions. Ocular involvement in RA is associated with increased pain and reflects systemic inflammatory burden. Ocular pain may serve as an early indicator of disease severity and requires integrated rheumatologic and ophthalmologic management.
Methods. A cross-sectional study included 54 patients with RA. Ophthalmologic evaluation identified corneoscleral involvement, including keratoconjunctivitis sicca and scleritis. Pain intensity was assessed using the visual analog scale. Clinical and biological data included disease duration, Disease Activity Score in 28 joints (DAS28), C-reactive protein (CRP), and autoantibody status.
Results. Ocular involvement was present in 35.2% of patients. These patients had significantly higher pain scores compared to those without ocular manifestations (6.6±1.1 vs 5.2±1.3; p=0.001). Disease activity was significantly higher in the ocular group (DAS28: 5.4±0.8 vs 4.2±0.9; p<0.001), indicating a link between systemic inflammation and ocular pain. CRP levels were also elevated (12.1±5.3 vs 7.4±4.6 mg/L; p=0.003) and correlated with pain intensity (r=0.33; p=0.01). Patients with scleritis exhibited the highest pain burden (VAS 7.1±0.9), compared to keratoconjunctivitis sicca (6.2±1.0; p=0.02). Multivariate analysis identified CRP (β=0.28; p=0.004) and DAS28 (β=0.35; p=0.001) as independent predictors of pain (R2=0.39).
Conclusions. Ocular involvement in RA is associated with increased pain and reflects systemic inflammatory burden. Ocular pain may serve as an early indicator of disease severity and requires integrated rheumatologic and ophthalmologic management.
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