The association of choroidal thickness with rheumatoid factor and anti-cyclic citrullinated peptide in rheumatoid arthritis



To measure ocular vascular parameters in rheumatoid arthritis patients and compare with those of controls and to evaluate the association of rheumatoid factor and anti-cyclic citrullinated peptide antibody with the choroidal thickness.


Superficial foveal vessel density, superficial and deep foveal avascular zone area, and subfoveal choroidal thickness were measured using the swept-source optical coherence tomography angiography. Multivariate linear regression was used to assess the correlation of subfoveal choroidal thickness with serological markers in patients with rheumatoid arthritis.


Choroidal thickness in patients was significantly thinner than that in healthy controls (278.87 ± 59.54 μm vs. 323.94 ± 98.02 μm, p = 0.03). Despite the weak positive correlations between rheumatoid factor/anti-cyclic citrullinated peptide and choroidal thickness, these relationships were not statistically significant (p > 0.05).


In patients with rheumatoid arthritis, subfoveal choroid was thinner than controls. There were similar correlations between choroidal thickness and rheumatoid factor and anti-cyclic citrullinated peptide antibody.

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  1. 1.

    Huizinga TW, Pincus T (2010) In the clinic. Rheumatoid arthritis. Ann Intern Med 153:1–15

  2. 2.

    Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094–1108

  3. 3.

    Silman AJ, Pearson JE (2002) Epidemiology and genetics of rheumatoid arthritis. Arthritis Res 4(Suppl 3):S265–S272

  4. 4.

    Aletaha D, Neogi T, Silman AJ et al (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581

  5. 5.

    Turesson C (2013) Extra-articular rheumatoid arthritis. Curr Opin Rheumatol 25:360–366

  6. 6.

    Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL (2003) Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 62:722–727

  7. 7.

    Moreland LW, Curtis JR (2009) Systemic nonarticular manifestations of rheumatoid arthritis focus on inflammatory mechanisms. Semin Arthritis Rheum 39:132–143

  8. 8.

    Vignesh APP, Srinivasan R (2015) Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies. Clin Ophthalmol 9:393–397

  9. 9.

    Schargus M, Wolf F, Tony HP, Meyer-Ter-Vehn T, Geerling G (2014) Correlation between tear film osmolarity, dry eye disease and rheumatoid arthritis. Cornea 33:1257–1261

  10. 10.

    Shahlaee A, Pefkianaki M, Hsu J, Ho AC (2016) Measurement of foveal avascular zone dimensions and its reliability in healthy eyes using optical coherence tomography angiography. Am J Ophthalmol 161:50–55

  11. 11.

    Coscas F, Sellam A, Glacet-Bernard A et al (2016) Normative data for vascular density in superficial and deep capillary plexuses of healthy adults assessed by optical coherence tomography angiography. Invest Ophthalmol Vis Sci 57:211–223

  12. 12.

    Yanık Odabaş Ö, Demirel S, Özmert E, Batıoğlu F (2018) Repeatability of automated vessel density and superficial and deep foveal avascular zone area measurements using optical coherence tomography angiography: diurnal findings. Retina 38:1238–1245

  13. 13.

    You Q, Freeman WR, Weinreb RN et al (2017) Reproducibility of vessel density measurement with optical coherence tomography angiography in eyes with and without retinopathy. Retina 37:1475–1482

  14. 14.

    Hirata M, Tsujikawa A, Matsumoto A et al (2011) Macular choroidal thickness and volume in normal subjects measured by swept-source optical coherence tomography. Invest Ophthalmol Vis Sci 52:4971–4978

  15. 15.

    Nickla DL, Wallman J (2010) The multifunctional choroid. Prog Retin Eye Res 29:144–168

  16. 16.

    Steiner M, Esteban-Ortega MDM, Munoz-Fernandez S (2019) Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: a review. Surv Ophthalmol 64:757–769

  17. 17.

    Ferreira CS, Beato J, Falcao MS, Brandao E, Falcao-Reis F, Carneiro AM (2017) Choroidal thickness in multisystemic autoimmune diseases without ophthalmologic manifestations. Retina 237:529–535

  18. 18.

    Ağın A, Kadayıfçılar S, Sönmez HE et al (2019) Evaluation of choroidal thickness, choroidal vascularity index and peripapillary retinal nerve fiber layer in patients with juvenile systemic lupus erythematosus. Lupus 28:44–50

  19. 19.

    Altınkaynak H, Duru N, Uysal BS et al (2016) Choroidal thickness in patients with systemic lupus erythematosus analyzed by spectral-domain optical coherence tomography. Ocul Immunol Inflamm 24:254–260

  20. 20.

    Ingegnoli F, Gualtierotti R, Pierro L et al (2015) Choroidal impairment and macular thinning in patients with systemic sclerosis: the acute study. Microvasc Res 97:31–36

  21. 21.

    Esen E, Taş DA, Sızmaz S, Türk I, Ünal I, Demircan N (2017) Evaluating choroidal characteristics in systemic sclerosis using enhanced depth imaging optical coherence tomography. Ocul Immunol Inflamm 25:356–362

  22. 22.

    Androudi S, Dastridou A, Symeonidis C et al (2013) Retinal vasculitis in rheumatic disease: an unseen burden. Clin Rheumatol 32:7–13

  23. 23.

    Tetikoğlu M, Temiztürk F, Sağdık HM et al (2017) Evaluation of the choroid, fovea and retinal nerve fiber layer in patients with rheumatoid arthritis. Ocul Immunol Inflamm 25:210–214

  24. 24.

    Akpek EK, Thorne JE, Qazi FA, Do DV, Jabs DA (2004) Evaluation of patients with scleritis for systemic disease. Ophthalmology 111:501–506

  25. 25.

    Duru N, Altınkaynak H, Erten S et al (2016) Thinning of choroidal thickness in patients with rheumatoid arthritis unrelated to disease activity. Ocul Immunol Inflamm 24:246–253

  26. 26.

    Kal A, Duman E, Sezenöz AS, Ulusoy MO, Kal Ö (2018) Evaluation of retrobulber blood flow and choroidal thickness in patients with rheumatoid arthritis. Int Ophthalmol 38:1825–1831

  27. 27.

    Ünal O, Can ME, Özcan A, Özcan ME, Erten S, Çağıl N (2019) Color Doppler imaging of ocular hemodynamic changes in patients with rheumatoid arthritis unrelated to disease activity. Rheumatol Int 39:1001–1006

  28. 28.

    Gök M, Karabaş VL, Emre E, Aksar AT, Aslan MS, Ural D (2015) Evaluation of choroidal thickness via enhanced depth-imaging optical coherence tomography in patients with systemic hypertension. Indian J Ophthalmol 63:239–243

  29. 29.

    Akay F, Gündoğan FC, Yolcu U, Toyran S, Uzun S (2016) Choroidal thickness in systemic arterial hypertension. Eur J Ophthalmol 26:152–157

  30. 30.

    Westedt ML, Herbrink P, Molenaar JL (1985) Rheumatoid factor in rheumatoid arthritis and vasculitis. Rheumatol Int 5:209–214

  31. 31.

    Rantapaa-Dahlqvist S, de Jong BA, Berglin E et al (2003) Antibodies against cyclic citrullinated and IgA rheumatoid factor predict the development of rheumatoid arthritis. Rheum Arthritis 48:2741–2749

  32. 32.

    Itty S, Pulido JS, Bakri SJ, Baratz KH, Matteson EL, Hodge DO (2008) Anti-cyclic citrullinated peptide, rheumatoid factor and ocular symptoms typical of rheumatoid arthritis. Trans Am Ophthalmol Soc 106:75–81

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Correspondence to Arif Ülkü Yener.

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Yener, A.Ü., Şahin, K. The association of choroidal thickness with rheumatoid factor and anti-cyclic citrullinated peptide in rheumatoid arthritis. Int Ophthalmol (2020).

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  • Rheumatoid arthritis
  • Choroidal thickness
  • Optical coherence tomography angiography
  • Rheumatoid factor
  • Anti-cyclic citrullinated peptide antibody