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E. Villani, D. Galimberti, F. Viola, C. Mapelli, C. Pirondini, F. Colleoni, N. Del Papa, R. Ratiglia; Inflammation in Dry Eye Associated With Rheumatoid Arthritis: Immunoenzymatic and in vivo Confocal Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):540.
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© ARVO (1962-2015); The Authors (2016-present)
To study the ocular surface inflammation, in relation to systemic disease activity, in rheumatoid arthritis (RA) patients, with or without secondary Sjögren’s syndrome (SSII).
The study was conducted in 2 steps. Step I. Twelve patients with RA associated with SSII and 12 patients with RA non-SSII were consecutively enrolled. SSII was diagnosed according to the American-European Consensus Group criteria and the RA activity was evaluated by the Disease Activity Score 28 (DAS 28). All the enrolled subjects had active RA (DAS 28 > 3.2). Each partecipant completed a questionnaire for a standardized evaluation of dry eye symptomatology (Ocular Surface Disease Index - OSDI) and underwent a full eye exam (including BUT, fluorescein and lissamine green staining, corneal apex sensitivity and Schirmer test) and a confocal microscopy examination (to investigate epithelial and stromal cells and sub-basal nerve plexus). We collected from each patient (with cellulose sponges, following a standardized procedure) tear fluid samples which were stored at -80°C. Step II. We evaluated the same patients enrolled in Step I after RA improvement (DAS 28 decrement > 1.2, compared with baseline) obtained by systemic therapy (no topical drugs allowed). We performed clinical evaluation, confocal microscopy examination and tear sample collection, as in Step I. In a single-experimental session, IL-1 alpha, IL-6, IL-8 e TNF alpha concentrations were quantified (ELISA) in all tear samples.
In RA with SSII patients, we found statistically significant differences between Step I and Step II in OSDI, BUT, fluorescein staining (P<0.05; paired T-test), dendritic cells density, IL-1 alpha and IL-6 concentrations (P<0.05, P<0.001 and P<0.01, respectively; Wilcoxon test). RA non-SSII patients didn’t show any significant difference between Step I and Step II.
In SSII patients, RA activity seems to have an important influence on the ocular surface inflammation as well as on dry eye signs and symptoms. RA without SSII doesn’t show similar results. These findings suggest the existence of relevant pathogenetic differences in autoimmune dry eye related to SSII or not.
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