Original article
Correlation Between Dry Eye and Rheumatoid Arthritis Activity

https://doi.org/10.1016/j.ajo.2005.05.025Get rights and content

Purpose

To evaluate the incidence of dry eye in rheumatoid arthritis (RA) patients with or without Sjögren syndrome (SS), and to investigate the correlation between dry eye and RA activity.

Design

Prospective case-control study.

Methods

In 72 RA patients, the severity of dry eye was assessed by the Schirmer test, tear break-up time, rose bengal staining, and fluorescein staining. The RA activity was evaluated by the Lansbury index (LI), which is based on the duration of morning stiffness, erythrocyte sedimentation rate (ESR), grip strength, and joint score.

Results

Ten percent of patients met the Japanese criteria for SS. No difference in dry eye tests or LI was observed between SS patients and non-SS patients. Even in the non-SS group, 90% of patients were diagnosed with probable dry eye. In SS patients, positive correlations were observed between LI and Schirmer test (P = .048), ESR and Schirmer test (P = .035), ESR and rose bengal staining (P = .001), and grip strength and rose bengal staining (P = .047). No such correlations were observed in the non-SS patients.

Conclusions

Dry eye is common in RA patients, including those without SS. We found that there was a correlation between LI and Schirmer test in RA patients with SS, but no correlation when the entire group was analyzed. Dry eye always should be taken into consideration regardless of the RA activity, because the severity of dry eye is independent of RA activity.

Section snippets

Methods

This study was a prospective case-control study. During October 2003 to November 2003, we examined 72 RA patients (five men and 67 women) at the Department of Joint Disease and Rheumatism, Nippon Medical School. We excluded patients who had any other ocular surface disease besides dry eye. The mean ± SD patient age was 64.0 ± 11.6 years (range 30 to 85 years). RA was diagnosed according to the American Rheumatism Association 1987 revised criteria for the classification of RA.11 Eleven patients

Results

We examined the percentage of RA patients with SS, dry eye, or both (Table 1). According to the Japanese criteria for SS, 10% of RA patients were diagnosed with SS. According to the Japanese criteria for dry eye, 92% of RA patients developed dry eye, including probable dry eye. Even in the non-SS group, 90% of patients were diagnosed with dry eye. The profiles of SS and non-SS patients are listed in Table 2. The difference in the age and sex of the members of these two groups was not

Discussion

Because one of the purposes of this study was to identify dry eye in ordinary RA patients, we examined patients who visited the department of rheumatology for rheumatic treatment and not patients who visited the ophthalmology department with ophthalmic symptoms. The reported incidence of dry eye in the normal population is generally 5% to 17%,16, 17, 18 but its incidence in RA patients is higher (19% to 31%).8, 9, 19, 20 In this study, the incidence of dry eye in RA patients (47%) was similar

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    • Cited by (0)

    See accompanying Editorial on page 898.

    M.F. and T.I. contributed equally to this work.

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