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ORIGINAL RESEARCH article

Front. Med.
Sec. Rheumatology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1422307

Dry Eye Disease and Spondyloarthritis: expanding the spectrum of systemic inflammatory disorders associated with ocular surface disease. Data from the International AIDA Network Spondyloarthritis Registry

Provisionally accepted
Antonio Vitale Antonio Vitale 1Valeria Caggiano Valeria Caggiano 1Eduardo Martin-Nares Eduardo Martin-Nares 2Nunzia Di Meglio Nunzia Di Meglio 1Cristian Sica Cristian Sica 1Andrea Hinojosa-Azaola Andrea Hinojosa-Azaola 2Maria Orsetta Perfetti Maria Orsetta Perfetti 1Alessandra Pagliara Alessandra Pagliara 1Giorgia Guidetti Giorgia Guidetti 1Alex Fonollosa Alex Fonollosa 3Roberta Lopez Roberta Lopez 1Jessica Sbalchiero Jessica Sbalchiero 1Jurgen Sota Jurgen Sota 1Ester Carreño Ester Carreño 4Perla Ayumi Kawakami-Campos Perla Ayumi Kawakami-Campos 2Stefano Gentileschi Stefano Gentileschi 1Alejandra de-la-Torre Alejandra de-la-Torre 5Gian Marco Tosi Gian Marco Tosi 1Maria Antonietta Mazzei Maria Antonietta Mazzei 1Alberto Balistreri Alberto Balistreri 1Bruno Frediani Bruno Frediani 1Luca Cantarini Luca Cantarini 1*Claudia Fabiani Claudia Fabiani 1
  • 1 University of Siena, Siena, Italy
  • 2 Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico City, Mexico
  • 3 Cruces University Hospital, Barakaldo, Spain
  • 4 Hospital Universitario Rey Juan Carlos, Madrid, Madrid, Spain
  • 5 Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, University of Rosario, Bogota, Cundinamarca, Colombia

The final, formatted version of the article will be published soon.

    Objective: Dry eye disease (DED) is a condition associated with a myriad of systemic disorders. According to recent preliminary data, axial spondylarthritis (axial-SpA) could represent a new entity associated with DED. Therefore, the aim of this study was to assess DED in axial SpA patients through quantitative and qualitative specific tests, to investigate the potential association between DED and ocular surface damage in axial-SpA patients, as well as to identify potential variables associated with DED. Methods: 71 patients with axial-SpA fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria and 19 healthy controls were enrolled. Both patients and controls underwent a complete ocular assessment aimed at evaluating tear film and ocular surface including Schirmer test, break up time (BUT), fluorescein and green lissamine staining. The Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. Results: DED symptoms were reported in 46 (64.8%) patients and 3 (15.8%) healthy controls (p=0.0004). The Odds Ratio to receive the diagnosis of axial-SpA according to the presence of dry-eye related symptoms was 9.2 (95% C.I. 2.72-42.52, p=0.001). Schirmer test values < 6 mm/5 minutes were observed in 31 (43.7%) axial-SpA patients and in 2 (10.5%) healthy controls (p=0.013); a BUT<5 seconds was observed in 34 (47.9%) axial-SpA patients and in 6 (31.6%) healthy controls. The median OSDI score resulted to be 22.9 (IQR=29.35) among axial-SpA patients and 0.0 (IQR=4.69) among healthy controls (p=0.009). Fluorescein and green lissamine staining of the ocular surface indicated a significantly higher Oxford scale grading in axial-SpA patients than healthy controls. Conclusions: axial-SpA patients often complain of eye dryness, which may be quantified with the self-administered OSDI questionnaire and objectively assessed through the tests commonly used for the diagnosis of DED. Patients suspected of having axial-SpA should routinely be asked about dry eye symptoms and evaluated for potential corneal and conjunctival damage.

    Keywords: Dry eye disease (DED), Spondyloarthritis, diagnosis, BUT (Break up time), Schirmer test, Ocular surface

    Received: 23 Apr 2024; Accepted: 14 Aug 2024.

    Copyright: © 2024 Vitale, Caggiano, Martin-Nares, Di Meglio, Sica, Hinojosa-Azaola, Perfetti, Pagliara, Guidetti, Fonollosa, Lopez, Sbalchiero, Sota, Carreño, Kawakami-Campos, Gentileschi, de-la-Torre, Tosi, Mazzei, Balistreri, Frediani, Cantarini and Fabiani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Luca Cantarini, University of Siena, Siena, Italy

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