Evaluation Of Dry Eye Disease In Systemic Lupus Erythematosus And Rheumatoid Arthritis And Its Association With Anti-Ss-A And Ss-B Autoantibodies

To estimate the prevalence of dry eye disease (DED) in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and to identify any association with anti-SS-A and SS-B autoantibodies

Department of Ophthalmology, Clinical Immunology, and Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry

The study included 90 RA patients [ACR/EULAR (2010) criteria], and 55 SLE patients [ACR/SLICC (2012) criteria], ≥18 years. The severity was calculated using Disease Activity Score – 28 (DAS – 28) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for RA and SLE respectively. A detailed history (ocular symptoms, duration of RA/SLE, medications, and co-morbidities) was noted. DED evaluation included the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire (subjective test), Tear film Break Up Time (TBUT), Sjogren's International Collaborative Clinical Alliance Ocular Surface Staining (SICCA OSS), and Schirmer`s test (objective tests). Anti-SSA and SS-B autoantibody levels were assessed using ELISA

Of the 55 SLE patients [men/women:4/51; age: 32.87 ± 9.44 years; SLE duration: 7 years (range:2-9)], 72.7% had no flare-up. The DED prevalence in SLE was 29.1% (by SPEED), 25.5% (by Schirmer’s test I), 65.5% (by TBUT), and 58.2% (by OSS). Of the 90 RA patients [men/women: 10/80; age 44.99 ± 10.4 years; RA duration: 6 years (range: 0.1-30)] 53.3% were in remission. The DED prevalence in RA was 57.8% (by SPEED), 33.3% (by Schirmer’s test I), 74.4% (by TBUT), and 68.9% (by OSS). 29.1% of SLE and 57.8% of RA were symptomatic (SPEED), but a greater proportion showed surface staining (OSS:58.2% in SLE, OSS: 68.9% in RA). Anti-SS-A and SS-B autoantibodies were found in 36.4% and 12.7% of SLE, and 11.1% and 3.3% of RA patients, respectively

Most RA and SLE patients had a greater prevalence of DED on objective tests, particularly ocular surface epithelial damage (SICCA OSS), than subjective tests suggesting subclinical DED related to ocular surface inflammation. They may progress to symptomatic DED in the future, underscoring the need for DED screening in these patients. The prevalence of DED exceeded anti-SS-A and SS-B autoantibody positivity, emphasizing the unexplored role of other factors in DED pathology