Prevalence of Dry Eye Syndrome and Sjogren’s Syndrome in Patients with Rheumatoid Arthritis
Panida Kosrirukvongs MD*, Panotsom Ngowyutagon MD*, Pawana Pusuwan MD**, Ajchara Koolvisoot MD***, Surasak Nilganuwong MD***
Affiliation : * Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Rheumatoid arthritis has manifestations in various organs including ophthalmic involvement. The present
study evaluates prevalence of dry eye and secondary Sjogren’s syndrome using salivary scintigraphy which has not been used
in previous reports.
Objective : To evaluate the prevalence of secondary Sjogren’s syndrome in patients with rheumatoid arthritis, including
clinical characteristics and dry eye, compared with non-Sjogren’s syndrome.
Design : Descriptive cross sectional study.
Material and Method: Sixty-one patients with rheumatoid arthritis were recruited at Siriraj Hospital during March 2009-
September 2010 and filled in the questionnaires about dry eye for Ocular Surface Disease Index (OSDI) with a history taking
of associated diseases, medications, duration of symptoms of dry eyes and dry mouth. The Schirmer I test without anesthesia,
tear break-up time, rose bengal staining score, severity of keratitis and salivary scintigraphy were measured and analyzed.
Results : Prevalence of secondary Sjogren’s syndrome and dry eye were 22.2% (95% CI 15.4 to 30.9) and 46.7% (95% CI
38.0 to 55.6), respectively. Dry eye interpreted from OSDI, Schirmer I test, tear break-up time and rose bengal staining
was16.4%, 46.7%, 82% and 3.3% respectively. Fifty-two percent of patients had a history of dry eye and dry mouth with mean
duration 27.4 and 29.8 months, respectively. Superficial punctate keratitis and abnormal salivary scintigraphy were found in
58.2% and 77.8%. Duration of rheumatoid arthritis, erythrocyte sedimentation rate were not correlated with secondary
Sjogren’s syndrome. Dry eye from OSDI with secondary Sjogren’s syndrome (33.3%) compared with non-Sjogren’s syndrome
(9.5%) was significant difference (p = 0.008). Adjusted odds ratio for secondary Sjogren’s syndrome in OSDI score > 25 was
13.8 (95% CI 2.6 to 73.8, p = 0.002) compared to OSDI score < 25.
Conclusion : Awareness and detection of dry eye syndrome and secondary Sjogren’s syndrome in rheumatoid arthritis was
crucial for evaluation of their severity and proper management.
Keywords : Dry eye, Sjogren’s syndrome, Rheumatoid arthritis, Ocular Surface Disease Index (OSDI)
