Ocular surface dryness and disease activity in rheumatoid arthritis patients attending rheumatology clinic at Alexandria Main University Hospital.

PURPOSE: To evaluate ocular surface dryness in patients with rheumatoid arthritis and to investigate its association with disease activity parameters.

METHODS

This cross-sectional study included adult RA patients attending the Rheumatology Outpatient Clinic at Alexandria Main University Hospital. All participants underwent rheumatologic evaluation including Disease Activity Score-28, laboratory assessment of rheumatoid factor, anti-cyclic citrullinated peptide antibodies, and C-reactive protein, as well as comprehensive ophthalmologic examination. Dry eye assessment included the validated Arabic Ocular Surface Disease Index, Schirmer tear test I with and without anesthesia, and fluorescein staining graded using the Oxford scale.

RESULTS

Thirty-one female RA patients were included, with a mean age of 45.32 ± 10.26 years. Most patients exhibited moderate disease activity (64.5%), followed by high (19.4%) and low activity (16.1%). Severe dry eye symptoms were reported by 87.1% of participants based on OSDI scores. Objective testing revealed reduced tear production in a substantial proportion of eyes, with severe aqueous deficiency detected in 11.3% without anesthesia and 21.0% after anesthesia. Fluorescein staining demonstrated predominantly minimal to mild epithelial changes. Correlation analysis showed no statistically significant associations between disease activity, inflammatory markers, serological status (RF and anti-CCP), disease duration, and any subjective or objective dry eye parameters.

CONCLUSION

Ocular surface dryness is highly prevalent among patients with rheumatoid arthritis, with severe symptoms frequently observed despite generally mild to moderate objective findings. The absence of significant correlations with disease activity, inflammatory markers, or disease duration suggests that dry eye in RA may occur independently of systemic disease status. Routine ophthalmologic screening should therefore be considered for all RA patients regardless of disease activity.