Evaluation of the ocular surface in rheumatoid arthritis patients on conventional synthetic disease-modifying antirheumatic drugs.

PURPOSE: To evaluate and compare ocular surface findings in rheumatoid arthritis (RA) patients on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

MATERIALS AND

METHODS

The files of adult patients (≥18 years of age) diagnosed with rheumatoid arthritis (RA) according to the 2010 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis were reviewed retrospectively. RA disease activity was evaluated according to the DAS-28 score, and patients with similar severity of disease were enrolled. Patients who received hydroxychloroquine, methotrexate, and leflunomide treatments were defined as groups 1, 2, and 3, respectively. Ocular surface evaluation, Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test, tear break-up time (TBUT), Oxford scoring according to corneal and conjunctival fluorescein staining (CFS), conjunctival impression cytology (CIC) and the presence of posterior blepharitis were noted and statistically compared between the groups.

RESULTS

The mean age of the 49 RA patients was 57.9±10.2 years; 39 were female, and 10 were male. The mean follow-up period for RA was 12.1±7.8 years. The patients numbered 19, 15, and 14 in groups 1, 2, and 3, respectively. The median OSDI questionnaire scores for the groups were 31.3 (19.2-68.75), 33.4 (19.7-69.7), and 49 (21.1-67.1), respectively (P>0.05). The median Schirmer 1 test was 9mm (2-14mm) in group 1, 8mm (4-20mm) in group 2, and 7mm (5-15mm) in group 3 (P>0.05). Tear film BUT was measured at 7 s (3-10 s), 5.5 s (2-10 s), and 5 s (2-10 s) in the groups, respectively (P>0.05). A statistically significant difference was not found in terms of the Oxford score, which evaluates staining of the ocular surface with fluorescein (P>0.05). According to the Nelson grading of CIC, a statistically insignificant difference was observed between the groups (P>0.05). The presence of posterior blepharitis differed statistically significantly among groups (P=0.003).

CONCLUSION

Although a grade 3 CIC score was observed at a higher rate in the leflunomide group, this difference was not statistically significant. In addition, posterior blepharitis was observed more frequently in patients on methotrexate.