Is dry eye disease in seropositive and seronegative primary Sjögren syndrome the same?

Abstract

Purpose : This study aimed to compare multiple dry eye disease (DED) parameters in patients with seropositive and seronegative primary Sjögren syndrome (1SS) and to determine if DED is comparable between the two groups

Methods : This was a prospective, consecutive and comparative cross-sectional cohort study. Only the right eyes were analyzed. Eighty eyes of 80 patients with 1SS diagnosed according to ACR/EULAR 2016 criteria were included, 55 were seropositive 1SS and 25 were seronegative 1SS. Seropositive 1SS patients had a positive Sjogren serology test, whereas seronegative 1SS patients had positive salivary gland biopsy and negative serology tests. DED signs were evaluated with the following tests: tear film osmolarity, tear film matrix metalloproteinase-9 (MMP9), ocular surface staining scores (Oxford, NEI-CLEK and SICCA OSS), tear break-up time (TBUT) and Schirmer without anaesthesia. DED symptoms were evaluated with ocular surface disease index (OSDI) and dry eye questionary 5 (DEQ-5) questionnaires. Analysis was performed with Chi-square and T-tests.

Results : The mean age was 52.2±12.7, 96.3% were female, and no differences in gender and age were observed between seropositive and seronegative 1SS groups (P>0.05). The mean outcomes ± standard deviation in seropositive versus seronegative 1SS were as follow: tear osmolarity (317.6 ± 25.2 vs 313.4 ± 17.6, P= 0.529), Oxford (4.8 ± 3.3 vs 3.3 ± 2.6, P= 0.109), NEI-CLEK (4.7 ± 4.0 vs 4.3 ± 3.6, P= 0.727), SICCA OSS (6.7 ± 3.9 vs 5.5 ± 2.9, P= 0.092), TBUT (4.5 ± 2.3 vs 5.0 ± 3.4, P= 0.476), Schirmer test (10.8 ± 10.9 vs 12.8 ± 11.3, P= 0.509), OSDI (43.5 ± 23.1 vs 46.1 ± 30.2, P= 0.098) DEQ-5 (11.5 ± 4.5 VS 11.9 ± 6.2, P= 0.446). MMP9 was positive in 15 (28.3%) and 3 (12%) eyes of 1SS+ and 1SS- patients respectively (P= 0.111).

Conclusions : No significant differences were observed in DED parameters between seropositive and seronegative 1SS patients, however, a trend towards more severity in DED signs was observed in seropositive 1SS. On the contrary, DED symptoms showed a nonsignificant trend towards greater OSDI scores in seronegative. Based on the findings of this study, both seronegative and seropositive 1SS have similar DED severity performance, but seropositive 1SS might present with more severe signs and seronegative 1SS with more severe symptoms. Further studies with a greater sample size are needed to confirm our findings.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.