Evaluation of Ocular Surface in Rheumatoid Arthritis Patients under Conventional Synthetic Disease-Modifying Antirheumatic Drugs

Abstract Purpose: To evaluate and compare ocular surface findings in rheumatoid arthritis (RA) patients under conventional disease-modifying antirheumatic drugs (DMARDs). Material and Methods: The files of adult patients (≥18 years) 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 received hydroxychloroquine, methotrexate and leflunomide treatments, were determined as group 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 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 numbers of patients were 19, 15, and 14 in group 1, 2, and 3, respectively. The median (min max) OSDI questionnaire scores for the groups were 31.3(19.2-68.75) ,33.4(19.7-69.7), 49(21.1-67.1), respectively (p>0.05). The median (min-max)) Schirmer 1 test was 9mm (2-14mm) in group 1, 8mm (4-20mm) in group 2, and 7mm (5-15mm) in group 3 (p>0.005). Tear film BUT test was measured as 7s (3-10s), 5.5s (2-10s), and 5s (2-10s) in the groups, respectively (p>0.005). Statistically significant difference was not found in terms of Oxford score which evaluates the staining of the ocular surface with fluorescein (p>0.005). According to the Nelson grading of CIC, statistically significant difference was observed between the groups. (p=0,016). The presence of posterior blepharitis was statistically significant different among groups (p=0.003). Conclusion: Grade 3 CIC score was highest in the patients under leflunomide therapy. Besides, posterior blepharitis was observed more frequently in the patients under methotrexate therapy.