PERIPHERAL ULCERATIVE KERATITIS IN THE SETTING OF RHEUMATOID-ARTHRITIS - TREATMENT WITH IMMUNOSUPPRESSIVE THERAPY

Peripheral ulcerative keratitis (PUK) is a rare but serious inflammato ry eye condition that can complicate rheumatoid arthritis. PUK can be a warning sign of impending vasculitis, and cytotoxic therapy may be n ecessary to induce remission. We have encountered three patients with PUK in the past year. Two patients had long-standing quiescent rheumat oid arthritis who developed photophobia. Diagnosis was made by slit la mp examination. Treatment with local cyclophosphamide and prednisone r esulted in prompt remission of the ulcer within 8 weeks. Cytotoxic the rapy was discontinued altogether within 6 months. The third patient wa s also treated successfully with oral steroids and azathioprine. In al l patients, sicca was noted, None of them had any evidence of systemic vasculitis. PUK, when recognized early and treated aggressively, can result in remission of the ulcer and in the prevention of vasculitis. Keratoconjunctivitis sicca can accompany PUK independent of the activi ty of rheumatoid arthritis. (C) 1995 by W.B. Saunders Company