Sudden onset visual impairment and deafness in a patient with "long standing rheumatoid arthritis".

RP, a 52 years housewife was seen by us for the first time on 1st October, 2001. She had polyarticular pains and swelling since 20 years, involving small and large joints symmetrically. She had been diagnosed to suffer from rheumatoid arthritis and had received non-steroidal antiinflammatory drugs (NSAIDs), steroids and ayurvedic treatment intermittently over the past 20 years but had never received disease modifying antirheumatic drugs (DMARDs) for her illness. She had progressively become disabled and walked with an aid. One month before she saw us she developed sudden onset bilateral progressive blurring of vision. There was minimal pain in the eyes but no local redness or dryness. She was seen by an ophthalmologist who diagnosed iridocyclitis and treated her with local steroid instillations along with oral steroids with improvement in 3-4 days. One week later she developed sudden onset bilateral hearing loss accompanied by vertigo. There was no history of fever, headache, vomiting, otalgia, otorrhoea, cough or dyspnoea. There was no history of diabetes mellitus, hypertension or ingestion of ototoxic drugs. Audiogram revealed bilateral sensorineural hearing loss. She was started on oral prednisolone 30 mg/d with partial improvement of hearing and decrease in vertigo. She was seen by us 15 days later while still on 30 mg/day of prednisolone.