Retinal and choroidal microvascular changes in rheumatoid arthritis: A Cross-Sectional OCT-A Study

Purpose: To investigate retinal and choroidal microvascular alterations in patients with rheumatoid arthritis (RA) via optical coherence tomography angiography (OCT-A) and explore the influence of serological autoantibodies on choroidal thickness (ChT). Methods: This cross-sectional study included 28 patients with RA and 28 matched controls. The participants underwent comprehensive ophthalmological examinations, OCT-A scans to assess vessel density, and choroidal thickness measurements. Statistical analyses included t tests, Mann–Whitney U tests, Spearman’s correlation, and ANOVA. A p value < 0.05 was considered significant. Results: A total of 28 RA patients and 28 matched controls were analyzed. No significant differences were found in age, height, or weight between the groups. Compared with controls, RA patients had significantly lower Schirmer’s test scores and visual function scores and lower intraocular pressure (p < 0.05 for all). Vessel density analysis revealed significant reductions in the parafoveal temporal, perifoveal temporal, and perifoveal superior quadrants in RA patients. Choroidal thickness was significantly reduced in the perifoveal temporal and superior quadrants (p < 0.001). Anti-cyclic citrullinated peptide (anti-CCP) levels correlated significantly with parafoveal nasal vessel density (r = 0.542, p < 0.01) and perifoveal inferior vessel density (r = 0.377, p < 0.05). Logistic regression revealed increased parafoveal nasal choroidal thickness as an independent predictor of anti-CCP seropositivity (p = 0.034, OR = 4.739). No significant associations were found between the neutrophil‒lymphocyte (N/L) ratio and ocular parameters. Conclusion: These findings suggest that RA is associated with subtle yet significant alterations in the retinal microvasculature and choroidal thickness, particularly in relation to anti-CCP antibody positivity, indicating a potential role for ocular imaging as a biomarker for systemic disease activity in RA patients.