Ocular manifestations of RA are diverse and range from mild, asymptomatic findings to aggressive, vision-threatening disease. RA is often associated with secondary Sjögren's syndrome (keratoconjunctivitis sicca), which can manifest with eye dryness, foreign-body sensation in the eye, or photophobia. Both scleritis and episcleritis are associated with RA. Scleritis may be associated with severe corneal inflammation, leading to a corneal melt, or with scleromalacia perforans. Chronic inflammation, resulting in perturbation of the intraocular anatomy, can lead to glaucoma. Corticosteroid therapy can be an important factor in cataract formation.
Meta-analyses of placebo-controlled trials suggest that testosterone therapy in physiological doses is significantly associated with increased haematocrit, reduced high-density lipoprotein cholesterol and prostatic symptoms. 29 , 30 If prostate cancer has been excluded, there appears to be no increased risk of induction by testosterone therapy. There is inconsistent evidence regarding the risk of cardiovascular events. 29-31 A recent meta-analysis suggested increased cardiovascular risk and reported publication biases. 32 Long-term safety data are lacking, but recent reports more strongly suggest an increased risk of cardiovascular events in older men. 3 , 4 This has prompted the Endocrine Society to issue a warning statement. 5 The results and safety of long-term prospective controlled trials of testosterone therapy are awaited.