Patients with Rheumatoid Arthritis Experience Increased Dry Eye Disease Risk

Ying-Hsuan Tai, MD, MS

Patients with rheumatoid arthritis (RA) have an increased risk of dry eye disease (DED) and corneal surface damages compared to non-RA controls, finds new research.

The associations were generally consistent across the subgroups of age, sex, use of systemic corticosteroids, and comorbidity levels in the 12-year population-based matched cohort.

“Regular ophthalmology surveillance might be needed to mitigate the adverse effect of corneal inflammation on this susceptible population,” wrote corresponding author Ying-Hsuan Tai, MD, MS, Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University.

Tai cites common ocular manifestations of RA can include corneal inflammation, lacrimal gland dysfunction, and uveitis, which share similar pathogenic mechanisms to DED. The relationship between RA and DED is not yet fully understood and relevant risk factors for corneal surface damage remain mostly unknown.

Investigators here conducted a population-based cohort study using Taiwan’s National Health Insurance (NHI) research database to clarify the temporal association between RA and aqueous-deficient DED or corneal surface damage. With current evidence, they hypothesized that RA was associated with more aqueous-deficient DED and corneal surface damage in the nationwide autoimmune population.

Inclusion criteria were patients with at least two rheumatology clinic visits with the diagnosis of RA between January 2002 to June 2013. The primary outcome was DED, defined as the diagnosis made twice by certified ophthalmologists with prescriptions of cyclosporine ophthalmic emulsion treatment in the ophthalmology service. Secondary outcomes were secondary Sjögren’s syndrome (SS) and severe corneal surface damages.

The propensity score matching analysis generated 33,398 matched pairs with 501,377 person-years of follow-up. Those with RA were more likely to have coexisting diseases, higher Charlson comorbidity index scores, use of systemic corticosteroids, and higher number of hospitalizations and emergency room visits.

During the follow-up period, the incidence of DED was 23.14 and 10.25 per 1000 person-years in the RA and non-RA groups, respectively. Data show RA was significantly associated with more DED compared to non-RA controls (aHR, 2.03; 95% CI, 1.93 – 2.13; P <.0001), as well as increased SS (aHR, 4.11; 95% CI, 3.69 – 4.58; P <.0001). Subgroup analyses suggest consistent associations between RA and DED, including by age group, sex, Charlson comorbidity index scores, and the use of systemic corticosteroids.

Meanwhile, the incidence of corneal surface damage was 3.07 and 2.23 per 1000 person-years in the RA and non-RA groups, respectively. After adjusting for covariates, the team observed RA was significantly associated with more corneal surface damage than non-RA controls (aHR, 1.36; 95% CI, 1.21 – 1.51; P <.0001). Other independent factors for corneal surface damage identified were age (aHR, 1.01) and sleeping disorders (aHR, 0.80).

“Future studies are warranted to clarify the biological mechanism and to evaluate the effective prophylactic and therapeutic strategies for corneal complications in RA,” Tai added.

The study, “Rheumatoid Arthritis Associated with Dry Eye Disease and Corneal Surface Damage: A Nationwide Matched Cohort Study,” was published in the International Journal of Environmental Research and Public Health.