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Rachel Lim, Dinesh Gunasekeran, Jeggrey Kam, Bernard Thong, Rupesh Vijay Agrawal; Ocular Involvement In Sjogren’s syndrome – The Singapore Sjogren’s Syndrome Study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3879. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Sjogren’s syndrome may present with both ocular and extraocular manifestations. This study aims to compare and contrast ocular and extraocular manifestations in consecutive patients with Sjogren’s Syndrome (SS) recruited from rheumatology and ophthalmology outpatient clinics in Singapore.
Computerized Physician Order Entry records of patients with physician-diagnosed SS between 1993 and 2013 were retrospectively analyzed. Patients were grouped into different categories from 1 to 10 based on the number of organ-systems involved including ocular involvement.
A total of 355 patients were included, with a majority being females(94.6%); and Chinese (84.5%). Mean duration of disease was 8±4 years. While 135 (38.0%) fulfilled American European Consensus Group (AECG) criteria for diagnosis, only 24 (6.8%) fulfilled Sjögren's International Collaborative Clinical Alliance (SICCA) criteria for SS. Primary-SS comprised 76.9%, secondary-SS 23.1%; with the most prevalent associations of rheumatoid arthritis (11.8%) and systemic lupus erythematosus (11.3%). The most common ocular manifestations were keratoconjunctivitis sicca (KCS) (91.0%), anterior uveitis (2.54%), episcleritis (2.54%), lacrimal gland enlargement (1.69%) and retinal vasculitis (0.28%). The most common extraocular manifestations were musculoskeletal (75.2%), lymphoreticular (47.6%) and constitutional (41.7%). All patients had at least 1 other extraocular organ-system involved, with median number of systems affected being 4 in 26% patients, and maximum of 10 organ-systems affected in 1 (0.28%) patient. Ocular-musculoskeletal involvement was the most common combination (244 patients, 68.73%). Anti nuclear antibody (ANA) was tested positive in 298/343 (86.9%) with titres of ≥ 1:320 in 193/298 (64.8%), rheumatoid factor (RF) was positive in 191/280 (68.2%), anti-Ro in 241/350 (68.9%), and anti-La in 90/314 (41%). Hydroxychloroquine (83.4%), methotrexate (14.4%) and azathioprine (12.4%) were the most commonly used therapies.
Keratoconjunctivitis sicca is the commonest ocular manifestation of Sjogren's syndrome. 90% of the patients had two or more organ-systems involved, with musculoskeletal involvement being the most common.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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