Inflammatory Cytokine Interleukin-36 Expression In Dry Eye Patients With Polyautoimmunity

 Polyautoimmunity (PAI) are patients with more than one distinct autoimmune disease. These patients are often associated with greater severity of systemic disease and also worse ocular surface inflammation. We aim to present the relationship between autoimmune disease activity by analyzing cytokine expression and the severity of ocular surface damage.

Tertiary Medical Center

We conducted a retrospective cross-sectional study of PAI patients in regards to clinical disease activity by OSDI scores, slit lamp evaluation of lid margins, tear film break up time (TBUT), fluorescein staining scores, and Schirmir tests. Schirmir strips were collected and tear fluid eluted for cytokine analysis. Patients with positive serology for Sjogren’s syndrome (SS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and their combinations were enrolled. Enrollees were divided into five groups: Primary SS, SS+RA, SS+SLE, RA+SLE, and RA+SS+SLE (MAS). Each group was subdivided into those with or without dry eye disease (DED). Laboratory profile and medications use were compared between the groups.

A total of 139 PAI patients, including 11 patients with three or more autoimmunity diseases (MAS, multiple autoimmune disease) were included. All MAS patients presented with DED and corneal complications. The incidence of corneal complications in MAS was significantly higher than the other groups (All p < 0.005). As for laboratory data, ESR was higher in MAS compared to the other groups. Topical medications were more frequently prescribed in MAS compared to the other groups (All p < 0.01). IL-36 were higher in patients with RA. 

MAS commonly presented with ocular surface complications, with more topical medication use. ESR is a useful indicator of systemic disease activity or the severity of ocular surface damage in PAI patients. Rheumatologists should refer patients especially those with PAI to ophthalmologists to prevent severe corneal complications.