Could primary open-angle glaucoma (POAG) be an autoimmune disease like rheumatoid arthritis (RA)? Korean researchers at Seoul’s Yonsei University think it is, believing it may share an underlying autoimmune component with RA. Learn why older adults with RA may be at higher risk for POAG than adults without the autoimmune condition.*

Researching POAG risk with RA

In an article published in JAMA Network Open, the researchers explain that RA is a progressive, inflammatory autoimmune disease that sometimes, but not always, attacks the joints. Multiple factors, such as autoantibodies and immune complexes, are involved in its development. POAG is also suspected of having an immunological origin, among other proposed causes, since lowering eye pressure (the main treatment approach) isn’t always successful at preventing optic nerve and visual field damage, even when at below-normal levels.

While it is premature to state definitively that all POAG is autoimmune-related, studies going back more than 20 years have pointed to POAG having such an origin. Research over the past five years has resulted in significant support of this theory. 

What the researchers did

For this most recent study, the researchers aimed to determine POAG risk in older Korean adults diagnosed with RA versus those without RA (controls).

• Records of more than a half-million adults over the age of 60 were extracted from the South Korean National Health Insurance-Senior Cohort database from 2002 to 2013.
• 2,049 adults with RA were identified and matched for comparison to 8,196 non-RA controls by factors such as age, sex, income, concurrent conditions, and frequency of healthcare use.
• The goal was to pair subjects on susceptibility to developing POAG.

What they found

In medical research, person-years are the cumulative number of years that all participants are involved in a particular study.

• Of the 2,049 adults with RA, 981.1 were diagnosed with POAG per 100,000 person-years.
• Of the 8,196 matched controls (without RA), just 679.5 were diagnosed with POAG during the same time frame.

Looking more closely, two factors were linked to highest POAG risk.

• RA diagnosis within two (2) years
• Being 75 years of age or older

What it means

The study adds more proof that people with RA are at greater risk of developing POAG, particularly in those of older age and those with a recent RA diagnosis.

It’s still uncertain whether or not autoimmune disease drugs are effective against POAG. If they are, it would lend proof that all POAG is autoimmune. The study does, however, establish a link between POAG and RA on a national scale.

The authors say it’s unlikely that RA itself directly causes POAG, but they posit that the two conditions may share a common disease pathway that could be immune-related.

“Considering that POAG has an insidious onset over decades, our results suggest that the immune complex involved in RA has the potential to simultaneously cause damage to tissues that are associated with the development of POAG including the retina or optic nerve.” A “paradigm shift” may be necessary, they say, when thinking and speaking about POAG.

*Gever, J. (2022, March 21). Glaucoma: The Newest Autoimmune Disease? MedPage Today. https://www.medpagetoday.com/rheumatology/arthritis/97787