Background Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents. Case presentation Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a pre-perforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye.Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms. Conclusions Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.

中文翻译：

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生物治疗成功治疗类风湿性关节炎穿孔性角膜溃疡2例。

背景 外周溃疡性角膜炎 (PUK) 是一种严重的炎症性眼部疾病，可影响长期患有类风湿性关节炎 (RA) 的患者。生物疗法的使用彻底改变了 RA 的治疗，并提供了令人鼓舞的结果，特别是在少数病例报告的 PUK 治疗中。在这篇文章中，我们描述了两名有穿孔性角膜溃疡病史的 RA 患者，他们通过生物制剂成功治疗。病例介绍 病例 1：一名 45 岁的女性被诊断为 17 年以上的血清阳性 RA，对常规合成改善疾病的抗风湿药物 (csDMARDs) 无效。她接受了一个周期的利妥昔单抗治疗，临床和生物学失败。2017 年 7 月，她出现活动性 RA 耀斑，左眼疼痛，视力下降。眼部检查显示左眼角膜穿孔，右眼穿孔。她连续三天接受了 1 g/天的甲基强的松龙紧急推注，随后是英夫利昔单抗。13 个月后，英夫利昔单抗对风湿性疾病和角膜受累有效，因为它停止了右眼的逐渐穿孔，并稳定了左眼的角膜溃疡。病例 2：一名 68 岁男子自2010 年 2017 年 7 月因右眼角膜穿孔而对 csDMARDs 耐药的血清阳性 RA。他因眼部受累和活动性类风湿性关节炎住院。他连续三天接受了 500 mg/天的甲基强的松龙紧急推注，随后是利妥昔单抗。六个月后，我们观察到右眼角膜损伤的稳定和关节症状的消退。结论 我们的病例表明英夫利昔单抗（病例 1）和利妥昔单抗（病例 2）作为治疗活动性 RA 并发症的严重和破坏性角膜角质松解的疗效，允许计划角膜移植。这种积极的治疗反应将有助于增加关于这种治疗成功的文献报道。