Prevalence of Dry Eye Disease in Rheumatoid Arthritis Patients

Abstract

 

Purpose

 

Patients with rheumatoid arthritis (RA) often present to non-eye care practitioners with dry eye disease (DED) symptoms but without a clinical diagnosis of DED. We completed a prospective, observational 1-visit multi-center clinical study to determine the prevalence of DED on a large RA patient population recruited from non-eye care settings.

 

Methods

 

286 adult RA patients completed a rheumatologic and dry eye evaluation. All patients were asked to self-report a clinical diagnosis of DED. The mean age of patients was 58 years old; 14.3% were male and 85% were female, with unavailable gender information for 0.70%. The following rheumatologic tests were performed: Disease Activity Score in 28 joints (DAS28) and Cyclic Citruillinated Peptide IgG antibody (CCP IgG), C - Reactive Protein (CRP), and Rheumatoid Factor (RF) labs. The following dry eye tests were performed: Ocular Surface Disease Index® (OSDI), tear osmolarity (TO), tear break-up time (TBUT), corneal/conjunctival staining, and Schirmer test (ST) without anesthetic. A Modified Dry Eye WorkShop (DEWS) Severity Scale (Table 1) was created to quantify DED severity level. A DED severity level was determined for each eye by averaging the severity level for each test. The eye with the higher DED severity level was used to identify each patient’s overall DED severity level. Patients with an overall DED severity level greater than Level 1 were defined as having DED.

 

Results

 

Data from the 286 RA patients was analyzed. 44% of patients reported a clinical diagnosis of DED. Mean rheumatologic test results were: DAS28 3.04±1.40, CCP IgG 91.77±105.80, CRP 0.58±1.58, and RF 77.44±109.73. Mean dry eye test results were: OSDI 37.21±25.54, TO 316.26±16.32, TBUT 4.20±2.05, staining 4.45±4.52, and ST 11.15±8.99. The prevalence of DED (overall DED severity level greater than Level 1) in RA patients recruited from non-eye care settings is 96.15%. 34.27% of RA patients had an overall severity of at least Level 3.

 

Conclusions

 

In this population of RA patients recruited from non-eye care settings there is a strong association between RA and DED. Earlier diagnosis and treatment of DED in collaboration with non-eye care professionals and eye care professionals in RA patients is essential.<br />  

 

Table 1: Modified DEWS Severity Scale