All patients had a long history of high-titer seropositive, nodular, erosive RA which on presentation of PUK had been quiescent or well controlled for many years.13 In our study the mean duration of RA among the patients with vision threatening complications like sclerosing keratitis and PUK was 10.5 years which was comparable to the abovementioned studies in which the CASIN vision threatening complications were associated with longer duration of the disease. mean duration of rheumatoid arthritis in patients with ocular manifestations was 5.42.7 years and without ocular manifestations was 2.11.6years. Three percent of the patients had episcleritis (six patients). Scleritis was present in 2% of the patients (four patients). Peripheral ulcerative keratitis and sclerosing keratitis was present in 1% of the population each (two patients each). Eighty-five percent (66 patients) had bilateral manifestations 15% (eleven patients) had unilateral manifestations. There was a strong association between the presence of anti-CCP antibodies and ocular manifestations of rheumatoid arthritis which CASIN was shown by the statistically significant em P /em -value of 0.0001. Conclusion Ocular manifestations are a significant part of the extra-articular manifestation of rheumatoid arthritis. Dry vision was the most common ocular manifestation. There was a statistically significant association between the presence of anti-CCP antibodies specific to rheumatoid arthritis and the ocular manifestations. strong class=”kwd-title” Keywords: rheumatoid arthritis, ocular manifestations, anti-CCP antibodies, dry vision, scleritis, peripheral ulcerative keratitis Introduction Rheumatoid arthritis (RA) Rabbit Polyclonal to AP2C is usually a chronic progressive, antibody mediated autoimmune disease that primarily affects small joints. It also involves other organs and ophthalmic involvement is usually often significant, causing varying degrees of ocular morbidity. Ocular CASIN manifestations of RA include dry vision, episcleritis, scleritis and peripheral ulcerative keratitis (PUK).1 Although rheumatoid factor (RF) is commonly used for diagnosis, anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) are a more sensitive and specific marker of CASIN systemic involvement in RA than rheumatoid factor antibody. Anti-CCP antibody is usually emerging as the preferred diagnostic marker for RA especially in early cases. It also predicts the future occurrence of the disease in undifferentiated arthritis. The sensitivity and specificity of anti-CCP reactivity for RA patients diagnosed based on American College of Rheumatology criteria were detected as 73.5% and 100%, respectively which shows it to be a highly sensitive and specific marker for the disease. 2 In this study we correlate the presence of ocular manifestations and the presence of anti-CCP antibodies. Methodology The study group consisted of 196 patients who presented for the first time to the outpatient clinic of the department of ophthalmology and immunology. The study was approved by the institutes ethics committee. Inclusion criteria All patients with RA undergoing routine ophthalmologic screening. Exclusion criteria Presence of other autoimmune systemic disorders like systemic lupus erythematosus, graft versus host disease, and any immunosuppressive disorders. History of radiation. Drug induced ocular manifestations which includes hydroxychloroquine induced maculopathy and other effects induced by chronic immunosuppression. Age less than 18 years. Parameters studied CASIN in the patient The age, sex, and demographic data were initially collected from the patient. A detailed anterior segment examination using slit lamp was done to detect episcleritis, scleritis, and corneal changes. Dry eye examination was done using Schirmers test, tear film break-up time, and ocular staining score. Fundus examination was done to detect any posterior segment manifestations. The anti-CCP antibody levels were detected using enzyme-linked immunosorbent assay (ELISA); and chi-square test was used to correlate their significance to ocular manifestations. Procedure Patients were subjected to a thorough clinical examination to confirm the diagnosis of arthritis. Erythrocyte sedimentation rate, auto-antibodies specific to RA, and X-rays were done in all patients. The anti-CCP antibody level was detected using ELISA test (DIASTAT; Axis-Shield Diagnostics Ltd., Dundee, Scotland, UK). Serum samples collected from patients were used for the ELISA test. A positive test was considered if levels were 5 U/mL.2 The diagnosis of RA was made based on the American Rheumatism Association 1987 revised criteria for the diagnosis of RA.3 History of the ocular symptoms was obtained and ocular examination was done in every patient with torch light and slit lamp biomicroscopy. Schirmers test was done using Whatman filter paper and tear film break-up time was done using fluorescein stain in all patients to assess lacrimal function. Ocular surface involvement was assessed by Rose and fluorescein Bengal staining. The analysis of dry attention was predicated on the American-European Consensus Requirements for Sj?grens symptoms which includes the current presence of a connective cells disorder, length of symptoms three months, rip film break-up period 10 mere seconds, Schirmers check (without anesthesia) 5 mm/5 mins, Van Bijsterveld rating 4,4 the analysis of scleritis,.