Association Between Early Sjögren Markers and Symptoms and Signs of Dry Eye

Abstract

Purpose: Animal models suggest that early markers of Sjögren syndrome (EMS)—antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)—are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS. Methods: In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ2 test, Fisher exact test, independent sample t test, and Spearman correlation. Results: Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures. Conclusions: Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE.

Case–Control Study Examining the Composition of the Gut Microbiome in Individuals With and Without Immune-Mediated Dry Eye

“…Cases included individuals with DE symptoms and/or signs, who had pSS as defined by the 2016 American College of Rheumatology criteria 15 [total weighted score of $4: 1) anti-SSA/ Ro and anti-SSB/La antibody positivity; focal lymphocytic sialadenitis with a focus score $1 foci/4 mm 2 , each scoring 3; 2) ocular staining score of $5; Schirmer #5 mm/5 minutes; unstimulated salivary flow rate of #0.1 mL/min, each scoring 1, n = 1] or had an elevation of at least 1 of 9 early SS markers (IgM, IgA, or IgG antibodies against SP1 (n = 5), PSP (n = 7), or CA6 (n = 13) at a level of 20 EU/mL or greater, n = 19). 13 In this study, 12 cases had 1 elevated early SS marker, 6 cases had 2 elevated markers, and 1 case had 4 elevated markers. Controls included age-matched and sex-matched individuals without DE symptoms or signs, including tear breakup time (TBUT) $5 seconds, corneal staining score #2, and Schirmer score $5 mm in both eyes.…”

“…12 In fact, early marker positivity is more common than late marker positivity (antibodies to Ro and La) in individuals with DE, found in up to 73% of individuals with DE symptoms and suggestive clinical signs (eg, aqueous tear deficiency or ocular surface inflammation). 13…”

The Diagnostic Performance of Early Sjögren’s Syndrome Autoantibodies in Juvenile Sjögren’s Syndrome: The University of Florida Pediatric Cohort Study

“…The latter study showed an association of eSjA with severe sicca symptoms, but eSjA did not differentiate SS-dry eye from non-SS dry eye. Similarly, anti-CA6 was most frequently elevated in patients with dry eye condition and a clinical suspicion of SS when a defined population of US veterans in Miami was screened (52). There were no demographic or comorbidity differences between eSjA-positive and eSjA-negative subjects, and eSjA did not correlate with more severe tear film measures.…”

Utilizing Baidu Index to Investigate Seasonality, Spatial Distribution and Public Attention of Dry Eye Diseases in Chinese Mainland

“…This may be due to differences in the study population, with adolescents likely to be more adept at accessing information from the internet. In addition, adolescents might have subjective symptoms of DED but do not meet the actual diagnostic criteria for field epidemiological studies ( 40 , 41 ). The frequency analysis of hot words related to DED mainly includes three aspects: other associated ocular diseases, treatment options and the subjective symptoms of patients.…”