Arthritis and the Eyes

Arthritis includes over 100 different conditions that affect joints and their surrounding tissue. Many forms of arthritis are debilitating and can interfere with mobility and quality of life. The two main categories of arthritis are degenerative and inflammatory.   

Degenerative Arthritis  

The most common form of arthritis is osteoarthritis (OA). According to the Centers for Disease Control and Prevention, this form of degenerative arthritis affects more than 32.5 million adults in the United States. Experts estimate more than 80% of adults 55 and older have osteoarthritis. Some individuals might never experience symptoms. OA involves the wearing away of the cartilage that caps the bones in your joints. As a degenerative joint disease, it can affect many joint tissues. Weight-bearing joints — knees, hips, the lower back, neck, hands, and spine are impacted. OA is a disease of the entire joint, including:  

  • bone,  
  • cartilage,  
  • ligaments,  
  • fat and  
  • the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape, cause inflammation, pain, stiffness, and swelling, and limit mobility. 

Contributing Factors 

Factors that may contribute to the development of osteoarthritis include: 

  • Gender- Women are more likely to develop arthritis than men. 
  • Genetics- People with family members who have arthritis are more likely to develop it. 
  • Age- The risk of developing arthritis increases with age, and symptoms typically appear in people over 50.  
  • Overuse- Using the same joints repeatedly in a sport or a job can result in osteoarthritis. 
  • Obesity- Excess weight adds stress and pressure on a joint, and fat cells promote inflammation. 
  • Weak muscles- If muscles do not provide adequate joint support, poor alignment can lead to arthritis. 
  • Musculoskeletal abnormalities- Malalignment of bone or joint structures can contribute to faster development. 
  • Joint injury- A bone fracture or tear of the cartilage or ligament can lead to osteoarthritis, sometimes more quickly than in cases with no obvious injury. 

Symptoms  

While symptoms of osteoarthritis typically show up more often in individuals over age 50, arthritis can affect younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. Osteoarthritis typically develops slowly over time, but after an injury, it can develop much more rapidly, within a few years.  

Symptoms include:  

  • Pain or aching in a joint during an activity, after a long activity, or at the end of the day 
  • Joint stiffness usually occurs first thing in the morning or after resting 
  • Limited range of motion that may go away after movement 
  • Clicking or popping sound when a joint bends 
  • Swelling around a joint 
  • Muscle weakness around the joint 
  • Joint instability or buckling (as when a knee gives out) 

Risk of Falls 

Research indicates people with osteoarthritis experience more falls and risk of fracture than those without the condition. Although study results vary, some research shows individuals may have up to 30% more falls and a 20% greater fracture risk. Having osteoarthritis can:  

  • decrease function,  
  • weaken muscles,  
  • affect overall balance and  
  • increase the likelihood of falls, especially among those with osteoarthritis in their knees or hips. Side effects from pain medications, such as dizziness, can also contribute to falls. 

Treatment 

There is no cure for osteoarthritis, but medication, assistive devices, and physical therapy can help ease pain. No one wants to exercise when pain exists, but exercise is key to maintaining mobility. A severely damaged joint may be surgically fused or replaced with one made of a combination of metal, plastic and/or ceramic, such as a knee or hip replacement.   

Inflammatory Arthritis  

Inflammatory arthritis is a systemic disease. The immune system mistakes the body’s cells for foreign entities and releases inflammatory chemicals that attack those cells. Rheumatoid arthritis (RA) is the most well-known example. RA is a chronic autoimmune disease that attacks the synovium, the tissue lining around a joint that produces fluid to help the joint move smoothly. The inflamed synovium gets thicker, making the joint feel painful and tender. It can cause redness, swelling, and difficulty in moving the joint. 

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. 

RA tends to be symmetrical. An individual will have problems in the same joints on both sides of their body — both wrists or both knees. In some people, the condition can damage a wide variety of body systems including:  

  • the skin,  
  • eyes,  
  • lungs,  
  • heart and  
  • blood vessels.  

Rheumatoid and other types of inflammatory arthritis often develop first in the small joints of your hands, wrists, and feet. The cause of rheumatoid arthritis is unclear, but it is thought to involve a combination of genetic and environmental factors. The underlying mechanism involves the body’s immune system attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage. 

Symptoms 

In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain. 

Signs and symptoms of rheumatoid arthritis may include: 

  • Morning stiffness that lasts for 30 minutes or longer 
  • Joint pain, tenderness, swelling, or stiffness that lasts for six weeks or longer 
  • More than one affected joint 
  • Small joints (wrists, certain joints in the hands and feet) are typically affected first. 
  • The same joints on both sides of the body are affected 
  • Fever, fatigue, and loss of appetite are common. Many people with RA get very tired from fighting inflammation, and some may have a low-grade fever. Symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months. Flares alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place. 

Signs and Symptoms that do not Affect Joints 

About 40% of people who have rheumatoid arthritis also experience signs and symptoms that do not involve the joints. Areas that may be affected include: 

  • Skin – Rheumatoid nodules, small lumps under the skin over bony areas 
  • Eyes – Dryness, pain, inflammation, redness, sensitivity to light, and trouble seeing properly 
  • Lungs – Inflammation and scarring can lead to shortness of breath and lung disease 
  • Heart – Inflammation can damage the heart muscle and the surrounding areas 
  • Blood vessels  - Inflammation of blood vessels that can damage the nerves, skin, and other organs 
  • Red blood cells – Lower count than normal  
  • Painful joints also make it hard to exercise, leading to weight gain. Being overweight may make people with RA more likely to develop high cholesterol, heart disease, high blood pressure, and diabetes.  

Other areas of the body that can be affected include:   

  • Kidneys 
  • Salivary glands 
  • Nerve tissue 
  • Bone marrow 

More women than men get RA, and it usually develops in middle age. Onset for women is between ages 30 and 60, and for men, age 45. Having a family member with RA increases the odds of developing it. 

Researchers are not certain why people develop RA. They believe individuals may have genes that are activated by a trigger in the environment, such as a virus or bacteria, physical or emotional stress , or some other external factor. 

Diagnosis 

Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. It is sometimes challenging since its symptoms are similar to other health conditions. A rheumatologist, a specialist who diagnoses and treats inflammatory conditions that affect the joints, tendons, ligaments, bones, and muscles, is the best person to make a correct diagnosis. They will use medical history, a physical examination, imaging (X-ray and MRI) and lab tests to determine the next steps. 

Treatment 

RA treatment goals include:   

  • Stopping or reducing the inflammation to the lowest possible level, essentially putting the disease in remission) 
  • Relieving symptoms 
  • Preventing joint and organ damage 
  • Improving function and overall well-being 
  • Reducing long-term complications 

To meet these goals, a doctor will follow these strategies: 

  • Timely and aggressive treatment to reduce or stop inflammation as quickly as possible 
  • Targeting remission or another goal (called “treat-to-target”) to work toward few or no signs or symptoms of active inflammation. A treat-to-target approach includes the following steps:  
  • choosing the target;  
  • choosing how to assess the target;  
  • choosing when to assess the target and  
  • a commitment to changing course if the target is not achieved. 
  • Tight control to keep inflammation at the lowest level possible 

Self-care strategies like a healthy diet, exercise (or as much movement as possible), stress reduction, a positive attitude, and support systems are very important.   

Arthritis and Its Connection to Eye Health  

The connection between eye health and inflammatory arthritis occurs in two ways. In some cases, people do not find out they have a form of inflammatory arthritis until they develop eye symptoms, see an eye doctor, and get referred to a rheumatologist for further evaluation. Early signs of arthritis in the eye can be overlooked or misdiagnosed until additional systemic symptoms crop up. In other cases, people have inflammatory arthritis and develop eye complications that require ongoing management from an eye doctor. 

Rheumatoid arthritis damages the connective tissue covering the ends of joint bones. This connective tissue is made mostly of a substance called collagen. Collagen is also the primary substance of the eye’s sclera and cornea, so this is a way RA can affect parts of the eye.   

Communication between ophthalmologists, optometrists, and rheumatologists is key in managing eye manifestations of inflammatory arthritis. 

From infections to vision changes, various types of inflammatory arthritis can pose risks to specific parts of the eyes. Several eye conditions are associated with inflammatory rheumatoid arthritis because it is systemic.  

Dry Eye 

Dry eye refers to any condition that decreases moisture in your eyes. While it can affect anyone, it is also associated with rheumatoid arthritis. It can increase the risk of injury and infection because your tear glands protect your eyes. 

Scleritis 

Scleritis means inflammation of the sclera, which is the eye’s white area. It is comprised of connective tissue that forms the outer wall of the eye. It is susceptible to many types of arthritis. About half of all cases of scleritis are due to an underlying autoimmune disease such as rheumatoid arthritis, according to the American Academy of Ophthalmology. 

There are two main types of scleritis: anterior and posterior. The anterior portion is more likely to be associated with autoimmune arthritis. There are three types of anterior scleritis:   

  • Diffuse scleritis, which is the most common and most treatable 
  • Nodular scleritis, which causes nodules on the surface of the eye 
  • Necrotizing scleritis, the most serious form and most likely to cause painful symptoms and complications 

Scleritis symptoms include redness that does not go away with over-the-counter eye drops, severe pain, blurred vision, and light sensitivity. The eye can turn bluish-purplish red. The pain can be deep and searing. A danger of scleritis is that it can cause thinning of the cornea, which can increase the risk of eye tearing and partial blindness. 

Prompt treatment of scleritis is essential. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, corticosteroid pills, eye drops, or eye injections. Surgery may be needed in severe cases to repair eye damage and prevent vision loss. 

Earlier-onset Cataracts 

Inflammation from inflammatory arthritis such as rheumatoid arthritis can cause cataracts to develop sooner than is typical, and steroid medication used to treat inflammatory arthritis can increase the risk of developing cataracts, especially when used for long periods of time or in high doses. Fortunately, cataracts are treatable.   

Glaucoma 

Recurrent inflammation from rheumatoid arthritis contributes to glaucoma by increasing pressure in the eye, which can cause nerve damage over time. Glaucoma is also a potential side effect of steroid medication used to treat arthritis. 

Peripheral Ulcerative Keratitis 

Peripheral ulcerative keratitis (PUK) is a condition where the cornea in the front of the eye gets inflamed and is prone to thinning. Many people with PUK also have rheumatoid arthritis; 30 to 40 percent of PUK patients have RA, according to the American Academy of Ophthalmology. Peripheral ulcerative keratitis is also associated with other autoimmune or inflammatory disorders, including inflammatory bowel disease and lupus. 

Symptoms of PUK include pain, redness, reduced vision, light sensitivity, and tearing. The condition can be treated with artificial tears to help the cornea heal and antibiotic drops to help prevent infection. If there is ulceration in the eye, doctors may fill the ulcer with a special tissue adhesive and cover the sore with special contact lenses to control inflammation. 

Steroids are also used to control the inflammation in the eye, and disease-modifying drugs may be added or changed to help control systemic inflammation. Surgery may be needed to repair damage to the cornea. 

People with inflammatory arthritis should be sure to receive regular annual eye care, and ophthalmologists should remain in close communication with the patient’s rheumatologist.   

Practical Self-Help Tips 

  • Work for short periods, with planned rest periods in between. If you cook, keep a chair or stool near the stove so you can rest whenever necessary. 
  • Use a toaster, broiler oven, electric frying pan, crock-pot, or microwave oven for tabletop cooking to eliminate bending over the stove and oven. 
  • Arrange your storage facilities so the most frequently used items are within easy reach. 
  • To relieve pressure on your finger joints, use pieces of contrasting colored foam tubing over utensil handles. Try using a rocker knife, available in independent living catalogs, to slice foods. The sharp, curved blade slices through the food as you rock the handle up and down. 
  • Use a rubberized or vinyl jar opener for gripping doorknobs and appliance controls. 
  • Avoid lifting or carrying heavy household items. To transfer a pot from the counter to the stove, place the pot on a tray or cookie sheet with a raised rim and slide the tray along the counter instead of trying to lift the pot. 
  • Use a cart with wheels to move items from room to room and to offer support while walking. 
  • When you read, support your book with a folding book stand instead of trying to hold it open. 
  • Install drawers on gliding tracks that open and close with minimal effort. 
  • Try not to start projects early in the morning when pain and stiffness are most pronounced. Sometimes, a warm morning shower or bath can relieve joint pain. Be sure to use a bathtub bench or shower chair when bathing. 

Reproduced with permission of APH Press, American Printing House for the Blind, from Maureen A. Duffy, “Additional Health Conditions” in Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, pp. 99-100. Copyright 2002 by American Foundation for the Blind. All rights reserved. 

Resources for Arthritis 

The Arthritis Foundation 

American Academy of Ophthalmology