Severe Dry Eye Linked to Joint Inflammation in Primary Sjögren’s, Study Says

Patients with primary Sjögren’s syndrome and joint inflammation are significantly more likely to have severe or very severe dry eye, according to a multi-center study in Spain. The finding suggests a potential new strategy to identify signs of the disease that may lead to early treatment.

The study, “Factors associated with severe dry eye in primary Sjögren’s syndrome diagnosed patients,” was published in the journal Rheumatology International.

Dryness of the eyes is one of the most common symptoms of Sjögren’s syndrome patients. It happens as a result of white blood cell infiltration in exocrine glands, which are those that secrete substances like saliva, sweat, or tears.

Identifying the causes of severe or severe dry eye could “contribute to earlier diagnosis and treatment of the disease, and ultimately better long-term outcome,” researchers wrote. That’s why they set to investigate which factors are associated with the development of dry eye syndrome.

The study included 437 patients participating in the SJOGRENSER study – a Systemic Autoimmune Disease Group Project of the Spanish Society of Rheumatology. Among them, 95 percent were women, with a median age of 58 years, and a mean follow-up time of 8.3 years.

The majority of patients (94 percent) complained of daily, persistent, troublesome dry eye. Ninety two percent of them reported a sensation of sand and 16 percent developed a corneal ulcer, a painful open sore on the clear front surface of the eye.

In addition, 92 percent of patients failed the Schirmer’s test, which measures whether the eye produces enough tears to keep it moist, and 86 percent had severe or very severe dry eye.

Inflammatory articular (joint) involvement was significantly more frequent in patients with severe or very severe dry eye compared with patients without these conditions — 82.5 versus 69.5 percent. After accounting for sex, age, time of disease evolution, and disease severity, joint inflammation was significantly associated with severe or very severe dry eye. Specifically, patients with joint involvement were two times more likely to have the condition.

The findings suggest a potential strategy for ophthalmologists when diagnosing primary Sjögren’s syndrome. Before asking for more complex tests — blood tests or salivary gland biopsy, for example – physicians may look for other signs of Sjögren’s syndrome, such as joint inflammation or dry mouth. These are much easier to assess because they require non-aggressive, faster and less expensive examinations.

“These results suggest that a directed anamnesis [collection patient history] including systemic comorbidities, such as the presence of inflammatory joint involvement or dry mouth in patients with dry eye, would be useful to suspect a pSS [primary Sjögren’s syndrome],” the investigators concluded.