Correlation between Retinal Vasculature by Optical Coherence Tomography Angiography (OCTA) and Retinal Thickness in Rheumatoid Arthritis (RA) Patients with Different Disease Activity Scores
Authors: Kamel Khaled N , El-Shazly Amany Abd El-Fattah , Abdellatif Ahmed A , Abdel-karim Marwa A 
Published: November 2024

Abstract

Background
Rheumatoid arthritis (RA) is a systemic autoimmune disease which is characterized by inflammatory arthritis and extraarticular manifestations. It is a chronic inflammatory disease of unknown etiology which affects synovial joints. Its typical presentation starts with inflammation of small peripheral joints which is often symmetric then involves proximal joints if it is not treated. RA may affect the vascular tissue in the body including eye as it affects superficial and deep capillary plexus in foveal avascular zone (FAZ) area, superficial foveal vessel density and choroid. The Disease Activity Score (DAS)ESR is a major scoring system that evaluate activity of RA. The DAS score provides a score between 0 and 10, a larger number indicating more active disease. DAS28 score is calculated according to a formula that is composed of the number of tender joints and swollen joints and ESR.

Purpose
To investigate the correlation between retinal vasculature by OCTA and retinal thickness in RA patients with different disease activity scores

Materials and Methods
60 participants divided into three groups (mild, moderate, and severe) according to disease activity score (DAS), were included in this comparative cross-sectional study. Participants underwent a complete ophthalmologic assessment, measurement of RNFL thickness and retinal thickness using SD-OCT, vessel density using OCTA.

Results
There were significant difference in perifoveal nasal retinal thickness, parafoveal (inferior and superior quadrants) (superior hemisphere) (average parafoveal retinal thickness), peripapillary vessel density with increased disease activity score. There was no significant difference in RNFL thickness and retinal vessel density with increased disease activity score. There was significant relation between perifoveal retinal thickness in all quadrants and duration of treatment. There was significant relation between parafoveal retinal thickness in superior quadrants and duration of treatment. There was significant relation between DCP whole image and duration of treatment. There was no significant difference in RNFL thickness, OCTA of optic disc with increased duration of treatment. There was significant difference between 3 groups in RNFL thickness (temporal and inferior quadrants). There were significant differences in parafoveal retinal thickness (inferior quadrant. There were no significant differences between 3 groups regarding OCTA results.

Conclusion
retinal thickness in perifoveal and parafoveal superior quadrant and DCP vessel density showed decremental pattern with increased duration of treatment. RNFL thickness in temporal and inferior quadrants showed thinning with increased DAS28 score. Perifoveal retinal thickness in superior and inferior hemispheres, nasal and inferior quadrants showed thinning with increased DAS28 score. There was no correlation between DAS28 score, duration of treatment and CFT and FAZ.