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Rheumatoid arthritis-associated peripheral ulcerative keratitis outcomes after early immunosuppressive therapy
  1. Raul E Ruiz-Lozano,
  2. Eugenia M Ramos-Davila,
  3. Lucas A Garza-Garza,
  4. Kathia Gutierrez-Juarez,
  5. Julio C Hernandez-Camarena,
  6. Alejandro Rodriguez-Garcia
  1. Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Nuevo Leon, Mexico
  1. Correspondence to Dr Alejandro Rodriguez-Garcia, Hospital Zambrano-Hellion, Av. Batallon de San Patricio No. 112. Col. Real de San Agustin, San Pedro Garza Garcia, N.L. CP. 66278, Mexico; immuneye{at}


Background/aims To evaluate the role of early immunosuppressive therapy (IMT) in the management of rheumatoid arthritis (RA)-associated peripheral ulcerative keratitis (PUK).

Methods Single-centre, retrospective, comparative cohort study. Patients with RA-associated PUK were divided into two groups; those exposed to and those not exposed to early IMT, defined as administrating therapy within the first 4 weeks from the PUK onset. Outcomes included PUK recurrence, control of inflammation and development of ocular complications, including corneal scarring and perforation, cataract formation or progression and permanent visual loss.

Results A total of 52 eyes from 36 patients were included for analysis; 37 (71.2%) eyes received early IMT and 15 (28.8%) eyes did not. Follow-up time was 41.2+53.3 months (range: 4–236 months). While early IMT was a protective factor (HR 0.345, 95% CI 0.126 to 0.946, p=0.039), late RA diagnosis after PUK onset (HR 4.93, 95% CI 1.75 to 13.85, p=0.002) and retarded (≥2 months) control of inflammation (HR 8.37, 95% CI 1.88 to 37.16, p=0.005) were risk factors for PUK recurrence. Late IMT (OR 7.75, 95% CI 2.00 to 29.99, p=0.003), an unknown diagnosis of RA at first visit (OR 4.14, 95% CI 1.15 to 14.91, p=0.030) and at least one PUK recurrence (OR 6.42, 95% CI 1.71 to 24.07, p=0.006) were risk factors for visual loss. Survival analysis rendered eyes exposed to early IMT a lower risk of PUK recurrence (p=0.039).

Conclusion Eyes with RA-associated PUK exposed to early IMT were more likely to achieve earlier inflammatory control, fewer recurrences and had better visual outcomes.

  • Cornea
  • Immunology
  • Inflammation
  • Sclera and Episclera
  • Ocular surface

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors involved in the research contributed significantly to the research work done. Conceptualisation (RER-L, AR-G), methodology and data curation (RER-L, EMR-D, JCH-C), validation and resources and supervision (JCH-C, AR-G), formal analysis (EMR-D, JCH-C), investigation (RER-L, LAG-G, KG-J), writing—original draft (RER-L), writing—review and editing (all authors), visualisation (RER-L, JCH-C, AR-G), project administrator and guarantor (AR-G).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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