Ab0647 the Significance of a Comprehensive Examination of Dry Eye Disease in Primary Sjögren Syndrome and Its Relationship to Extraocular Manifestations

Abstract

BackgroundInflammation of the lacrimal glands leads to ocular dryness, an important cause of decreased quality of life in primary Sjögren’s syndrome (pSS) patients[1]. Limited data focuses on dry eye disease (DED) in pSS. Previous studies did not conduct a comprehensive evaluation of DED using tests to measure tear film volume or instability, ocular surface damage, meibomian gland dysfunction, and patient-reported outcomes, and the disease activity parameters were not compared with these ocular findings in pSS[2].ObjectivesThe aim of this study is to conduct a comprehensive evaluation of DED features in pSS patients using various methods and compare them to pSS disease characteristics and activity.MethodsThirty-four patients classified as pSS according to 2016 ACR/EULAR classification criteria[1]that are followed up in rheumatology clinic were included in the study. The patients had an ophthalmologic examination and DED evaluation on the day of their routine follow-up appointments. ESSPRI scores was recorded and laboratory tests, salivary flow rate and salivary gland ultrasonography(USG) scores of the patients were recorded from the patients’ files. The ophthalmologic examination includes Schirmer’s test, BUT, ocular surface staining (Oxford score), Marx’s line, and noninvasive BUT (NIBUT) with the Scheimplug-Placido disk system. Ocular surface disease index (OSDI) and dry eye questionnaire-5 (DEQ-5) were used for patient-reported outcomes. The relationship between the pSS-related parameters and the ophthalmologic findings was evaluated.ResultsThe patient characteristics are given in Table 1. According to the TFOS-DEWSII definition and classification report, all patients have definite DED[3]. The mean Schirmer’s test, BUT, and NIBUT were 3.4±5.2 mm, 5.9±3.0 sec, and 5.9±3.9 sec, respectively. The mean OSDI score was 38.2±22.7, indicating severe DED symptoms, and the mean DEQ-5 score was 10.3±6.0. Oxford score was positive in 25 (73.5%) patients. Marx’s line grading that shows meibomian gland dysfunction was 3.2±2.3.The mean ESSPRI score for dryness, pain, and fatigue were 6.5±2.1, 5.4±3.2, and 5.3±3.1, respectively. There was a significant positive correlation between the ESSPRI-dryness score and OSDI (p=0.001), DEQ-5 (p=0.004), and Oxford score (p=0.03).Also, there was a significant negative correlation between patient global assessment (PGA) of general health and DEQ-5 scores (p=0.007). And there was a significant positive correlation between PGA of disease activity and OSDI and DEQ-5 scores (p=0.02 and p=0.001).Although seventeen (50%) of the patients have decreased unstimulated salivary flow rate with a median of 0.16 (0.24) ml/min, no significant correlation was observed with DED. The results of salivary gland USG were present in 12 (35.2%) of the patients, and there were 7 patients with at least one gland with an OMERACT USG score ≥2. No significant difference was found between OMERACT USG score and DED parameters, although it remained within the statistical siginificant limit for OSDI score and OMERACT USG score ≥2 in the submandibular glands (p=0.054).There was no significant difference between the DED parameters and other pSS clinical parameters.ConclusionPatient-reported outcomes such as ESSPRI-dryness score, PGA of general health, and disease activity worsen as DED severity increases in pSS patients.References[1]Shiboski CH, et al. Ann Rheum Dis. 2017[2]Seror R, et al. Rheumatology (Oxford). 2019[3]Craig JP, et al. Ocul Surf. 2017Table 1.The characteristics of the study populationAge, years,mean±sd49.5± 13.3Sex, female,n (%)33 (97.1)Disease duration, months,median (IQR)73.5 (76.5)Treatment,n (%) Hydroxychloroquine Methotrexate Leflunomide Azathioprine Mycophenolate mofetil Rituximab24 (70.6)6 (17.6)6 (17.6)4 (11.8)2 (5.9)2 (5.9)Disease manifestations,n (%) Arthralgia Arthritis Parotitis Interstitial lung disease Lymphopenia Hypergammaglobulinemia Hypocomplementemia31 (91.2)11 (32.4)2 (5.9)4 (11.3)7 (20.6)12 (35.3)4 (11.8)Acknowledgements:NIL.Disclosure of InterestsNone Declared.