THE ASSOCIATION BETWEEN OCULAR CICATRICIAL PEMPHIGOID AND RHEUMATOID-ARTHRITIS

Purpose. To assess the pathogenesis, symptomatology, and severity of r heumatoid arthritis (RA) in patient's with concomitant ocular cicatric ial pemphigoid (OCP). Methods. We retrospectively analyzed the charts of eight patients seen at a single institution between the years 1972 and 1997 with concomitant RA and OCP. Patients with OCP secondary to m edical therapy, radiation, or chemical bums, or Stevens-Johnson syndro me were excluded. Results. The female-to-male ratio was 7:1. All patie nts had positive serum rheumatoid factors and immunohistochemical conf irmation of OCP. The mean number of years of RA prior to OCP diagnosis was 19. The number of patients with stage II OCP was three of eight ( 37.5%). The number of patients with stage III OCP was five of eight (6 2.5%). All patients had radiologic evidence of degenerative joint dise ase and synovial thickening. All eight patients had keratoconjunctivit is sicca, five of eight patients (62.5%) had Sjogren's syndrome, and f ive of eight patients (62.5%) developed rheumatoid cornea necrosis lea ding to corneal perforation. Conclusions. The implication exists that RA and OCP may be linked via an immunologically mediated mechanism and that patients with severe extraarticular symptoms associated with RA may be more likely to develop OCP. Prompt recognition of overlying sym ptoms may facilitate proper therapy for control of both diseases.