Evaluation of ocular surface involvement and systemic conditions in patients with autoimmune rheumatic diseases

Abstract Purpose: To evaluate and explore the ocular surface involvement and systemic conditions in autoimmune rheumatic diseases (ARDs). Methods: 79 patients with ARDs were enrolled in our study, including 26 patients with rheumatoid arthritis (RA), 33 patients with systemic lupus erythematosus (SLE), and 20 patients with primary Sjögren’s syndrome (pSS). All patients underwent ocular surface evaluation, including ocular surface symptoms and signs, conjunctival impression cytology, and tear multi-cytokine detection. The systemic conditions were also collected, including disease duration and disease activity. Results: SLE patients have the shortest disease duration and nearly half of them have low disease activity, while RA patients and pSS patients have a relatively long disease duration and about 90% of them have moderate/high disease activity. The incidence of dry eye and the levels of pro-inflammatory tear cytokine in SLE patients is significantly lower than RA and pSS patients, while there was no significant difference between RA and pSS patients. However, pathologic squamous metaplasia on the ocular surface is more severe in SLE and pSS patients than RA patients. Dry eye severity in all ARDs patients was shown independent of disease activity, while the ocular surface Nelson’s grades are positively correlated with disease duration in RA patients. Conclusions: Dry eye and ocular surface inflammation persist in most ARDs patients, and do not occur in parallel with the disease activity. Other than pSS, dry eye and ocular surface squamous metaplasia also exist in SLE and RA. Therefore, all patients with ARDs require a regular ophthalmologic evaluation and topical medications.