Rheumatoid arthritis (RA) may be associated with a higher risk of developing primary open-angle glaucoma (POAG), according to a study published in JAMA Network Open.
This risk was highest among patients with RA aged 75 and older, and within 2 years of the patient receiving a RA diagnosis.
Emerging evidence has demonstrated an association between autoimmunity and neurodegeneration in glaucoma, a leading cause of irreversible blindness. To better understand if there is a relationship between RA and the development of POAG specifically, the study authors conducted a data analysis between November 2020 and July 2021 using data from the Korean National Health Insurance Service-Senior (NHIS-Senior) cohort.
The cohort included data of more than half a million adults aged 60 and older between 2002 and 2013, but only 10,245 participants were included in this analysis. Of this group, 7490 (73.1%) were women and the mean (SD) age was 67.7 (4.84) years.
A total of 2049 patients in this group had newly-diagnosed incident seropositive RA and were prescribed biological agents or any disease-modifying antirheumatic drug (DMARD) during the timeframe. A control group of 8196 individuals without RA were included, matched by propensity score and risk set. The mean follow-up period was 4.5 years (2.49), generating 46,142 person-years.
The authors found that patients with RA were more likely to develop POAG compared with patients without RA in the control group (HR, 1.44; 95% CI, 1.13-1.84), with 86 (4.2%) patients with RA and 254 (3.1%) patients without RA developing POAG during the follow-up period. Additionally, the cumulative incidence of POAG was higher among patients with RA during the entire follow-up period.
For patients with RA, the incidence rate of POAG was 981.8 cases per 100,000 person years (95% CI, 794.3-1213.7 cases per 100,000 person years), while patients without RA had an incidence rate of 679.5 cases per 100,000 person years (95% CI, 600.8-768.3 cases per 100,000 person years).
Further, risk of developing POAG was mainly observed 2 years into follow-up (HR, 1.83; 95% CI, 1.28-2.61) and in individuals aged 75 years or older (HR, 2.12; 95% CI, 1.34-3.35) in the RA group. For new RA diagnoses, POAG risk was 1.5 times greater among patients with RA within 4 years of diagnosis, compared with patients without RA.
“It is well known that the prevalence of associated systemic symptoms, progression of the disease, and functional outcomes may vary depending on the age of onset of RA,” the authors said. “It is assumed that distinct characteristics of laboratory findings or phenotypes in late-onset RA, which are different from those of younger-onset RA, are associated with RA and subsequent risk of POAG, but additional studies should be considered.”
While this association was found, it does not necessarily indicate a directly causal relationship between RA and POAG. The authors emphasized this association should be further researched due to other antibody expressions and cell responses involved in RA that be simultaneously involved in the development of POAG.
“Our results agree with those of previous studies, which confirmed an association between the diagnosis of specific autoimmune diseases including RA and subsequent dementia within 5 years,” the authors said. “Considering that POAG has an insidious onset over decades, our results suggest that the immune complex involved in RA has the potential to simultaneously cause damage to tissues that are associated with the development of POAG including the retina or optic nerve.”
Kim SH, Jeong SH, Kim H, Park E, Jang S. Development of open-angle glaucoma in adults with seropositive rheumatoid arthritis in Korea. JAMA Netw Open. 2022;5(3):e223345. doi:10.1001/jamanetworkopen.2022.3345