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Rheumatoid factor, antinuclear antibody may portend primary Sjögren’s syndrome
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Specific diagnostic testing protocols may show signs of Sjögren’s syndrome in patients with clinically significant dry eye, according to a study.
The prospective multicenter study included 327 patients with clinically significant aqueous-deficient dry eye. Investigators conducted Schirmer testing, corneal fluorescein staining, conjunctival lissamine green staining and tear film breakup assessment. Patients also took a questionnaire on their history of systemic disease and dry eye.
Laboratory work-up was undertaken to assess Sjögren-specific antibody A, Sjögren-specific antibody B, rheumatoid factor (RF) and antinuclear antibody (ANA).
Study results showed that 38 patients (11.6%) had Sjögren’s syndrome; 21 patients (6.4%) had primary Sjögren’s syndrome and 17 patients (5.2%) had secondary Sjögren’s syndrome.
Results of conjunctival and corneal staining, Schirmer testing and symptoms were worse in patients with Sjögren’s syndrome than in those without Sjögren’s syndrome.
Patients with positive ANA and RF had a markedly greater likelihood of having primary Sjögren’s syndrome, the authors said.
Perspective
Back to TopEric D. Donnenfeld, MD
The authors have performed a prospective study of the incidence of Sjögren’s syndrome in patients with significant aqueous-deficient dry eye. The high percentage (23.2%) of patients with aqueous deficiency dry eye and Sjögren’s syndrome is surprising. The fact that the patients with more severe dry eye disease also were more likely to have Sjögren’s syndrome is not surprising. What is more important, however, is that 3% of patients were newly diagnosed by the ophthalmologist with Sjögren’s syndrome. My take-home message is that when a patient presents with significant dry eye disease (especially if they are young), then the ophthalmologist should order the appropriate tests or refer the patient for rheumatologic evaluation.
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