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Abstract RA is an immune-mediated inflammatory disorder that primarily affects the synovial joint and can result in deformity and disability but also has extra articular manifestations including vascular and eye affection. The choroid of eye is a vascular network located between retina and sclera that nourish the outer layer of retina. Spectral-domain optical coherence tomography (OCT) using enhanced depth imaging (EDI) is newly used as a non-invasive safe method for better visualization of the choroid. The aim of this work is to evaluate the choroidal thickness in rheumatoid arthritis patients and detect its relation to disease activity. Ethical written an informed consent was obtained from all subjects after a full explanation of the study according to the ethical committee of faculty of medicine, Menoufia University. Fifty patients suffering from Rheumatoid arthritis (46 female & 4 male) who had attended the outpatient clinic of physical medicine Rheumatology & Rehabilitation department, Menoufia University Hospitals from 2017 to 2021 were included in this study. All patients were diagnosed as RA according to the 2010 criteria of the American College of Rheumatology for RA. We examined their both eyes with OCT to evaluate the choroidal thickness in rheumatoid arthritis patients and detect its relation to disease activity. Their disease duration ranged from 2 to 18 years with a mean of 5.94 ± 3.48 years. One hunderd eyes of 50 healthy controls (45 females, 5 males) that were examined with OCT to assess normal choroidal thickness. The mean age of the RA patients was 34.18 ± 4.01 (range 19–39), and the control group was 32.54 ± 5.75 (range 18–39). There was no significant difference between the mean ages of the two groups according to the Student’s t test (p = 0.101). The male/female distribution of the two groups compared was similar. Patients presented with morning stiffness, joint pain, joint swelling involving especially small joints of the hands, deformities. Diagnosis was made according to the 2010 criteria of the American College of Rheumatology for RA. Evaluation of inflammatory activity was made using the Disease Activity Score (DAS- 28). Larsen score is used for the radiographic evaluation of joint damage. Exclusion criteria were prior history of intraocular surgery, prior history of ocular trauma, previous ocular disease such as retinal detachment, episcleritis, scleritis and uveitis. Smoking and alcohol use, diabetes mellitus, hypertension, glaucoma, pregnancy and high myopia or hypermetropia (>6 diopters). All patients were subjected to the following: demographic data, clinical assessment including medical history and clinical examination (general, complete joint examination, neurological examination and Ophthalmic examination), laboratory investigation including CBC, ESR, CRP, RF and Anti-CCP and imaging including Posterior-anterior radiographs of the hands and choroidal thickness was measured by enhanced depth imaging (EDI) optical coherence tomography (OCT) for both eyes of every subject. Subfoveal choroidal thickness was measured by Heidelberg spectral domain OCT (Heidelberg Engineering, Heidelberg, Germany) and software version 6.3.3.0. A superluminescent diode with a wavelength of 870 nm was used. The digital calipers provided by the Heidelberg Spectralis software were used to measure CT horizontally at the subfoveal region. CT was measured from horizontal sections obtained by OCT under the center of the fovea by the same ophthalmologist and averaged for analysis. Disease Activity Score 28 (DAS-28) was used to measure disease activity in patients. The score was calculated using the number of tender and swollen joints and the erythrocyte sedimentation rate. RA patients were divided into 2 subgroups as remission (DAS-28 ≤ 2.6) and active (DAS-28> 2.6). |