RESEARCH - Corneal involvement in RA: an in vivo confocal study

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Invest Ophthalmol Vis Sci. 2008 Feb;49(2):560-4.

Corneal involvement in rheumatoid arthritis: an in vivo confocal study.

Villani E, Galimberti D, Viola F, Mapelli C, Del Papa N, Ratiglia R.

Clinica Oculistica Università degli Studi di Milano, Fondazione

Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS

(Istituto Ricerca e Cura a Carattere Scientifico), Milan, Italy.

PURPOSE: To analyze the in vivo morphology of corneal cells and nerves

in patients with rheumatoid arthritis (RA), with or without secondary

Sjögren's syndrome (SSII), and to investigate the correlations between

corneal alterations and RA activity. METHODS: Fifty patients with RA

and 30 age- and gender-matched control subjects were studied. SSII was

diagnosed according to the American-European Consensus Group criteria,

and RA activity was evaluated by the Lansbury index (LI). Confocal

microscopy was used to investigate corneal thickness, the number of

epithelial and stromal cells, and keratocyte hyperreflectivity. In

addition, the sub-basal plexus was assessed for the number,

tortuosity, and reflectivity of the nerve fibers and the presence of

beadlike formations. RESULTS: Sixteen percent of patients with RA also

had SSII. Between the SSII and non-SSII groups, no significant

differences were found in the LI or in the clinical and confocal

variables. Significant differences were present between patients with

RA and control subjects for all the variables studied except nerve

reflectivity. In patients with RA with and without SSII, LI correlated

significantly with the number of beadlike formations and the number of

hyperreflective, activated keratocytes.

CONCLUSIONS: Confocal microscopy of patients with RA showed several

changes in corneal cells and nerves. The number of beadlike formations

and the number of activated keratocytes could be interpreted as

confocal signs of ocular surface disease activity. These correlations

with the index of systemic disease activity, LI, may provide insight

regarding the pathogenic mechanisms of dry eye in patients with RA.

PMID: 18234999

http://www.ncbi.nlm.nih.gov/pubmed/18234999

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