The relation between rheumatoid arthritis activity and dry eye disease

Aim of the work

To investigate the relationship between dry eye disease severity and disease activity in patients with rheumatoid arthritis (RA), emphasizing the role of non-contact meibography.

Patients and methods

A total of 40 patients with RA were enrolled. The disease activity score (DAS28) was assessed. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) titer, anti-cyclic citrullinated peptide (anti-CCP) titer, anti-SSA (anti-Ro) and anti-SSB (anti-La) antibodies were measured. Ophthalmological evaluations included the ocular surface disease index (OSDI) questionnaire, non-contact meibography scan, tear breakup time test (TBUT), and tear meniscus height (TMH).

Results

The patients’ age was 41.6 ± 8.2 years; 31 were females Patients with moderately and severely active RA exhibited significantly higher total meiboscore (3.4 ± 0.7 and 4.5 ± 0.5 respectively) than those in remission or with low disease activity (2.3 ± 0.5 and 2.6 ± 0.8 respectively) (p < 0.001). Similar results were noted on comparing TBUT (p = 0.01) and TMH (p = 023). There was no significant difference regarding dry eye symptomatology (p = 0.337). Total meiboscore significantly correlated with age (r = 0.36,p = 0.021), disease duration (r = 0.44,p = 0.005), DAS28-ESR (r = 0.82,p < 0.001), ESR (r = 0.68,p < 0.001), CRP (r = 0.53,p < 0.001), and RF titer (r = 0.52,p < 0.001). On linear regression, only DAS28 could predict the total meiboscore. An increase in DAS28 by one unit was associated with increase of total meiboscore by 0.5 with 95 %CI 0.35–0.64.

Conclusion

Rheumatoid arthritis patients with more active disease and prolonged duration of illness should be closely monitored for development of dry eye disease. Non-contact meibography is a valuable and innovative modality for evaluating meibomian gland dysfunction in RA patients, providing objective measurement of dry eye parameters.