A 60-year-old resident of Kalyan experienced an unexpected turn during a routine cataract surgery, as doctors discovered a rare ocular manifestation of rheumatoid arthritis (RA). The patient, Subhash Pardikar, a former employee of the Kalyan civic corporation, had no prior joint-related symptoms, which are typically associated with RA.
Unusual Presentation of Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disorder where the immune system mistakenly attacks the lining of joints. However, in Pardikar's case, the disease revealed itself through his eyes. He underwent cataract surgery on both eyes at a local eye hospital in February. While one eye healed normally, the other developed persistent redness, pain, and inflammation.
After a month of treatment with antibiotics, his ophthalmologist referred him to a senior doctor in Dadar. Dr. Sumeet Lahane of Raghunath Netralaya and MGM College, Navi Mumbai, explained, "Autoimmune peripheral ulcerative keratitis remains a rare but serious condition. It's associated with corneal thinning and loss of vision. In the initial stages, it may be difficult to diagnose."
Diagnosis and Treatment
Investigations revealed that Pardikar's RA markers were strongly positive. His rheumatoid factor was elevated, and RA-associated antibodies (Anti-CCP) exceeded 500. Despite these markers, he had none of the classic RA symptoms such as swollen joints, prolonged morning stiffness, or restricted movement. Dr. Snehal Patil, a rheumatologist from Fortis Hospital, Kalyan, who treated him, noted, "Autoimmune diseases don't always present in textbook fashion. In some patients, rheumatological conditions may affect organs like the eyes before other symptoms appear."
Pardikar had experienced intermittent joint pain four to five years ago, but the symptoms disappeared after a few months of Ayurvedic treatment. Dr. Patil diagnosed him with RA-associated autoimmune peripheral ulcerative keratitis, a rare but potentially blinding inflammatory eye condition.
Corneal Melt and Treatment
Pardikar had severe corneal melt, and his eye doctors used a "tissue glue" application to save his cornea. Dr. Patil initiated intravenous steroids, followed by oral steroids and an immunosuppressant drug called cyclophosphamide. Over the following weeks, inflammation subsided, corneal damage stabilized, and healing gradually began.
Dr. Lahane, who sees five to six such patients annually, stated that treatment is straightforward once the diagnosis is made. "In advanced cases, a patient may need a corneal graft," he added.
