Romatoid Artritli Hastalarda Gelişebilen Okuler Yüzey Bozukluğunun Tanı ve Tedavisinde Güncel Yaklaşımlar
Özet
Romatoid artrit (RA), toplumun %1-2'sini etkileyen sistemik bir otoimmün hastalıktır ve son yıllarda bu hastalıkla ilişkili oküler yüzey bozuklukları, özellikle kuru göz immünolojisi önem kazanmıştır. RA'da gözlenen oküler yüzey iltihabı ve sekonder Sjögren sendromu gibi tablolar, idiyopatik kuru göze kıyasla çok daha şiddetli seyrederek hastaların yaşam kalitesini olumsuz etkilemektedir. Hastalarda gözyaşı iltihabı belirteçleri ile sistemik inflamasyon arasında güçlü bağlar bulunmakta; TNF, IL17 ve IL6 gibi sitokinler hem eklemlerde hem de göz yüzeyinde doku hasarına yol açmaktadır. Geleneksel tedavilerde suni gözyaşları, kortikosteroidler ve siklosporin kullanılırken; glokom riski ve şiddetli vakalardaki yetersizlikler yeni arayışları doğurmuştur. Günümüzde, anti-TNF ajanlar (infliksimab, etanersept), B hücrelerini hedefleyen rituksimab ve sitokin sinyal yolaklarını baskılayan Janus kinaz (JAK) inhibitörleri (tofacitinib) gibi biyolojik ajanlar tedavi başarısını artırmaktadır. Ayrıca IL-1 reseptör antagonistleri ve trehaloz gibi lokal/topikal uygulamalar, sistemik yan etkileri azaltarak oküler inflamasyonu kontrol etmede umut vadetmektedir. Oftalmologlar ve romatologlar arasındaki multidisipliner işbirliği, bu karmaşık hastalık sürecinin erken tanısı ve yönetiminde kritik öneme sahiptir.
Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting 1-2% of the population, and in recent years, ocular surface disorders associated with this disease, particularly dry eye immunology, have gained importance. Ocular surface inflammation and conditions like secondary Sjögren's syndrome observed in RA are much more severe compared to idiopathic dry eye, negatively impacting patients' quality of life. There are strong links between tear inflammatory markers and systemic inflammation in patients; cytokines such as TNF, IL17, and IL6 cause tissue damage both in the joints and on the ocular surface. While artificial tears, corticosteroids, and cyclosporine are used in conventional treatments, glaucoma risks and inadequacies in severe cases have led to new pursuits. Today, biological agents such as anti-TNF agents (infliximab, etanercept), B-cell-targeting rituximab, and Janus kinase (JAK) inhibitors (tofacitinib) that suppress cytokine signaling pathways increase treatment success. Furthermore, local/topical applications like IL-1 receptor antagonists and trehalose show promise in controlling ocular inflammation while reducing systemic side effects. Multidisciplinary collaboration between ophthalmologists and rheumatologists is of critical importance for the early diagnosis and management of this complex disease process.
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