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Iritis and Rheumatoid Arthritis: Treatment  

While most people naturally think of joint problems with any arthritis, rheumatoid arthritis (RA) is a systemic illness and can affect many body parts. One site of RA trouble is in the eye with the development of iritis. Iritis means inflammation of the iris or colored part of the anterior or front of the eye. It is a specific form of uveitis, inflammation of the uveal tract of the eye.  

Just as happens with the joints, the iris is attacked in an autoimmune reaction when the body’s natural defense system goes haywire and attacks the body’s own organs. This autoimmune attack can damage the uvea and iris and lead to loss of vision if not treated. White and red blood cells are attracted to the area of inflammation and can cause adhesions and cataracts. The adhesions may cause intraocular pressure to go up which can damage the optic nerve and diminish vision.  

When the muscle that controls the iris, the ciliary body, is also affected, the condition is called iridocyclitis. This form of iritis is more common in children with juvenile rheumatoid arthritis (JRA) than it is in adults. Even worse, the chronic form of this condition may produce few or no symptoms while the eye is still being damaged. Children with JRA need regular eye exams to rule out this problem.  

In adults, uveitis is usually in the anterior eye involving mostly the iris but possibly the anterior chamber and/or ciliary body. When the posterior eye is involved, the condition is called choroiditis or retinitis depending on location. In acute iritis, usually only one eye is affected and is painful and red. There is also often excessive tearing and increased sensitivity to light, or photophobia. One way of telling iritis from ordinary conjunctivitis, or inflammation of the surface layer of the eye, is that the affected eye reacts when a bright light is applied to the unaffected eye. Vision is also usually blurry and occasionally “floaters” are seen.  

In the chronic form of iritis and other uveitis, the episodes may occur again and again and there may be few symptoms or even none at all. All RA patients needed preventative eye exams since damage can occur even when no symptoms are noticed. On eye exam, small keratitic deposits of white blood cells are seen and this is considered indicative of iritis. Later, cataracts may also form but can have other causes than just iritis.  

Treatment is aimed at controlling the underlying RA disease process, which also helps to prevent attacks of iritis or other uveitis. Despite white blood cells and redness, antibiotics are not needed or used to treat the condition, which should be managed by an ophthalmologist. Dilating eye drops are often used to treat iritis and steroids are usually given, both as drops and systemically. When glaucoma is present, it may require additional drugs to reduce pressure or even surgery. Good control of RA is the best general course of action.  

Resources  

Iritis defined: www.rheumatic.org/  

Diagnosis of rheumatoid iritis: www.diagnose-me.com/ 

General discussion of iritis: en.wikipedia.org/ 

Emergency room handling of RA iritis: www.emedicine.com/  

More about iritis and RA: www.medicalook.com/


RESOURCES:

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