Hidden arthritis nearly costs cataract patient his vision

Mumbai: A 60-year-old Kalyan resident’s routine cataract surgery turned into a race against time to save his eyesight, with doctors uncovering that he had an unusual symptom of an autoimmune disease called rheumatoid arthritis (RA).

RA is a condition in which the immune system mistakenly attacks the lining of the joints. But in the case of former Kalyan civic corporation employee Subhash Pardikar, there were no joint-related symptoms.

Pardikar underwent cataract surgery in both eyes at a local eye hospital in Feb. 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. “The Dadar doctor took one look at my right eye and asked me to consult a rheumatologist,” said Pardikar.

Investigations showed that Pardikar’s RA markers were strongly positive. “His rheumatoid factor was elevated, and RA-associated antibodies (Anti-CCP) exceeded 500. Yet he had none of the classic RA symptoms such as swollen joints, prolonged morning stiffness or restricted movement,” said rheumatologist Dr Snehal Patil from Fortis Hospital, Kalyan, who treated him.

Pardikar said he suffered intermittent joint pain four to five years ago. “But the symptoms disappeared after a few months of Ayurvedic treatment,” he said.

Dr Patil diagnosed that he had RA-associated autoimmune peripheral ulcerative keratitis, a rare but potentially blinding inflammatory eye condition. “Autoimmune diseases don’t always present in textbook fashion. In some patients, rheumatological conditions may affect organs like the eyes before other symptoms appear,” the doctor said.

Dr Sumeet Lahane of Raghunath Netralaya and MGM College, Navi Mumbai, said 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,” he said.

Dr Lahane, who sees five to six such patients annually, said the treatment is easy once the diagnosis is made. “In advanced cases, a patient may need a corneal graft,” he added.

Pardikar, too, had severe corneal melt, with his eye doctors using a “tissue glue” application to save his cornea. Dr Patil started him on intravenous steroids, followed by oral steroids and an immunosuppressant drug called cyclophosphamide. Over the following weeks, inflammation subsided, corneal damage stabilised and healing gradually began.