Anti-tnf Blockage May Improve Ocular Surface Parameters Of Patients With Rheumatoid Arthritis And Ankylosing Spondylitis

Abstract

Purpose: : To compare clinical and functional ocular surface parameters of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) before and after anti-TNF treatment.

Methods: : Twenty-nine patients with RA (n=15) and AS (n=14) were examined for dry eye. They were evaluated at baseline (BL), 3 (3M) and 12 months (12M) after anti-TNF treatment. The patients answered the Ocular Surface Disease Index (OSDI) questionnaire and underwent Schirmer’s I test, tear breakup time test (BUT), fluorescein and lissamine green staining as well as lesion grade of bulbar conjunctival cells by impression cytology.

Results: : Mean age of patients was 47.4±12.9 years, 59% were female gender and 93% Caucasian race. Mean disease duration was 19.9±9.4 and 17.8±11.8 years in RA and AS patients, respectively. Infliximab was used in 40% and 64.3% in RA and AS patients respectively; adalimumab in 46.7% and 28.6% in RA and AS, respectively and etanercept in 13.3% and 7.1% of RA and AS patients, respectively. Interestingly, there was an increase in Schirmer’s test values comparing BL with 3M evaluation in RA patients (16.9±12.5 mm vs. 21.6±12.8 mm, p=0.01) while 12M: 20.5±11.7 mm values were comparable to BL evaluation. No differences were observed in these parameter for AS patients (BL: 15.0±10.5 mm, 3M: 18.3±11.1 mm, and 12M: 18.5±10.1 mm). Remarkably, a significant improvement of the cytological lesion grade was achieved at 12M evaluation in AS patients (BL: 78.6% vs. 12M: 35.7%, p=0.031). BUT, fluorescein, lissamine green staining and OSDI scores were similar before and after treatment for RA and AS patients.

Conclusions: : Anti-TNF therapy may promote recovery of tear production in AR patients and improve conjunctival cytological lesion grade in AS subjects

Keywords: cornea: tears/tear film/dry eye • autoimmune disease • conjunctiva