The eye: a window of opportunity in rheumatoid arthritis?

Abstract

Rheumatoid arthritis (RA), the most common autoimmune disorder associated with dry eye syndrome, is also associated with sight-threatening ocular diseases such as peripheral ulcerative keratitis, scleritis and corneal melts. Tissue damage on the ocular surface of patients with RA is autoimmune-mediated. Findings from patients with dry eye have implicated defects in innate immunity (Toll-like receptors, S100A and resident antigen-presenting cells), cytokines, chemokines and T helper (TH)-cell subsets (including TH1 and TH17) in disease pathogenesis. Some of these features are probably important in dry eye related to RA, which can occur at a different time from articular disease and is more clinically severe than idiopathic dry eye. Ocular surface immune factors can be influenced by the systemic immune landscape. Depending on the severity of ocular inflammation in RA, treatment can include ciclosporin, topical corticosteroids, tacrolimus, autologous serum and systemic immunosuppression. Tissue damage is treated by inhibiting matrix metalloproteinases. Potential therapeutic strategies benefit from an improved understanding of ocular surface immunology, and include targeting of T-cell subsets, B-cell signalling or cytokines.

Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies

“…Tear film osmolarity also correlates with dry eye activity. Tong et al found in a recent study that tear film osmolarity correlated with the dry eye severity score 8. All this suggests that more research is needed on the markers of ocular surface in RA.…”

“…All this suggests that more research is needed on the markers of ocular surface in RA. Tong et al studied the immune factors that lead to dry eye and correlated them with systemic disease which could lead to potential treatment targets in the future showing the importance of conducting further studies on the ocular surface in RA patients 8. Villani et al studied the effect of immunosuppression on the ocular surface via confocal microscopy and cytokines level and found that immunosuppression modified the ocular surface pathology in RA patients with secondary Sjögren’s syndrome 9.…”

Tissue resident memory T cells in the human conjunctiva and immune signatures in human dry eye disease

“…Animals with defects in regulatory T cells exhibit more severe DED2627. The importance of T cells in human DED is underscored by the efficacy of cyclosporine, a T cell immunosuppressant that is a cornerstone of DED therapy282930. Here, we use impression cytology and flow cytometry to determine the distribution of T RM and recirculating T cell subsets at the ocular surface in healthy humans and in patients with dry eye disease.…”

Fluctuations of Corneal Sensitivity in Dry Eye Syndromes—A Longitudinal Pilot Study

“…Dry eye related to immunologic diseases has been described as the most severe form of dry eye. 25 Accordingly, we hypothesize that immunologic alterations of the ocular surface induce the most pronounced corneal nerve fiber damage. However, as this was an observational study, cause and effect (etiology vs. CoS) cannot be differentiated.…”