Clinical Characteristics Of Dry Eye In Patients With Autoimmune Rheumatic Diseases

PurposeTo evaluate the changes in dry eye symptoms and signs of patients with autoimmune rheumatic diseases,and to investigate the prevalence and clinical features of dry eye in patients with autoimmune rheumatic diseases.Materials and MethodsA total of 152 patients with autoimmune rheumatic diseases in the Department of Rheumatology,Qilu Hospital of Shandong University from June to December in 2021 were collected as the observation group.Another 55 age and gender-matched healthy subjects were recruited as the control group.According to the duration of disease,the observation group was divided into 3 groups:short course group(course≤2a),medium course group(2a<course≤10a),long course group(course>10a).According to the diagnosis,the observation group was divided into four groups:RA group,SLE group,SS group,and other cases group.Age,gender,course of disease and serum indexes were observed and recorded,and ocular examinations included OSDI questionnaire,Schirmer Ⅰ test,fluorescein breakup time,ocular surface fluorescein staining and meibomian gland function observation were performed.ResultsThere were no significant differences in age and gender between the observation group and the control group(age:t=-0.106,P=0.916;gender:χ2=0.002,P=0.969).Compares with the control group,patients with autoimmune rheumatic diseases were more prone to dry eye(33.6%vs.12.7%,P=0.003).Compared with the control group,the OSDI score,Schirmer Ⅰtest,breakup time,meibomian gland function observation and ocular surface fluorescein staining were all worser with statistical significance(P<0.01).The prevalence of dry eye in SS,RA and SLE groups was significantly higher than that in the control group respectively(P<0.05).There was significant difference in dry eye prevalence among different diagnosis groups(χ2=12.764,P=0.005).Pairwise comparison showed that the prevalence of dry eye in patients with SS was significantly higher than that in patients with RA,SLE or other rheumatoid autoimmune diseases(P<0.01),but there was no significant difference in the prevalence of dry eye between patients with RA,SLE or other diseases(P>0.05).There were statistically significant differences in OSDI score,SIt,BUT and FS(P<0.05),but no statistical differences in meibomian gland function(P>0.05)among different diagnosis groups.Pairwise comparison of OSDI score showed that the OSDI score of patients with SS was significantly higher than that of the other three groups(P<0.01).Pairwise comparison of SIt showed that the tear secretion of patients with SS or RA was significantly lower than that of patients with SLE(P<0.01),and the tear secretion of SS group was significantly lower than that of other diseases group(P=0.009).The BUT of patients with SS was significantly lower than that of patients with SLE(P<0.05).Pair comparison of fluorescence staining results showed that the fluorescence staining score of SS group was significantly higher than that of the other three groups(P<0.01),but there was no significant difference among the other three groups(P>0.05).There was no significant difference in the prevalence of dry eye among different course groups(χ2=2.326,P=0.313).There were no significant differences in ocular examination results among different course groups(P>0.05).There was no significant difference in ESR and CRP levels between ARDs patients with dry eye and patients without dry eye(P>0.05).ESR level in patients with dry eye was higher than that in patients without dry eye in different disease groups,but the difference was not statistically significant(P>0.05).RF level in patients with dry eye was also higher than patients without dry eye in RA group,but there was no statistical significance(P>0.05).The disease activity of patients with SS complicated with dry eye was correlated with the severity of dry eye,and there was statistical significance(P=0.008).ESR was positively correlated with OSDI.CRP was negatively correlated with BUT,and positively correlated with FS.In patients with RA complicated with dry eye,CRP was negatively correlated with tear secretion,RF was positively correlated with OSDI and FS scores,and negatively correlated with BUT.ConclusionThe prevalence of dry eye in patients with autoimmune rheumatic disease is significantly higher than that in the healthy subjects.The prevalence of dry eye in patients with SS is the highest,and the prevalence of dry eye in patients with SLE or RA is also respectively higher than that in healthy subjects with statistically significance.There was no significant correlation between the duration of disease and the incidence of dry eye in patients with autoimmune rheumatic diseases.Patients with SS are more likely to experience dry eye symptoms and ocular surface epithelial damage than those with other autoimmune rheumatoid diseases.Patients with SS or RA are more likely to show reduced tear secretion than those with other autoimmune rheumatic diseases.Severity of dry eye in patients with SS or RA was positively correlated with activity of ARD.