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 association of anticyclic citrullinated peptide (anti‐CCP) levels with choroidal thickness (ChT). Methods This cross‐sectional study included patients with RA and matched controls. Subjects with retinal or optic disc abnormalities were excluded. Vessel density was measured using OCT‐A. ChT was measured using the enhanced‐depth imaging SD‐OCT. Between‐group differences in vessel density and ChT were evaluated, and their associations with anti‐CCP positivity were explored. Results A total of 28 RA patients (age, mean ± SD: 58 ± 11 years, female sex: 93%) and 28 matched controls (age, mean ± SD: 57 ± 10, female sex: 93%) were analyzed. Compared with controls, RA patients had significantly higher vessel density in the parafoveal temporal ( p = 0.003), perifoveal temporal ( p < 0.001), and perifoveal superior ( p = 0.010) quadrants. ChT was significantly higher in the perifoveal temporal and superior quadrants ( p < 0.001). Anti‐CCP levels correlated significantly with parafoveal nasal vessel density ( r = 0.542, p < 0.010) and perifoveal inferior vessel density ( r = 0.377, p < 0.05). Logistic regression identified increased parafoveal nasal ChT as a factor independently associated with anti‐CCP positivity ( p = 0.034, OR = 4.739). Conclusion These findings suggest that RA is associated with subtle yet significant alterations in the retinal microvasculature and ChT, particularly in relation to anti‐CCP positivity, indicating a potential role for ocular imaging as a complementary indicator of systemic disease activity in RA patients.