PT - JOURNAL ARTICLE AU - Ruiz-Lozano, Raul E AU - Ramos-Davila, Eugenia M AU - Garza-Garza, Lucas A AU - Gutierrez-Juarez, Kathia AU - Hernandez-Camarena, Julio C AU - Rodriguez-Garcia, Alejandro TI - Rheumatoid arthritis-associated peripheral ulcerative keratitis outcomes after early immunosuppressive therapy AID - 10.1136/bjophthalmol-2022-321132 DP - 2023 Sep 01 TA - British Journal of Ophthalmology PG - 1246--1252 VI - 107 IP - 9 4099 - http://bjo.bmj.com/content/107/9/1246.short 4100 - http://bjo.bmj.com/content/107/9/1246.full SO - Br J Ophthalmol2023 Sep 01; 107 AB - 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.Data are available upon reasonable request.