Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Findings in Ocular Examination of Patients with Systemic Sclerosis.

Tsifetaki3,  Niki, Papagoras3,  Charalampos, Paschides1,  Contantinos A., Drosos2,  Alexandros A.

Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
Ioannina Medical School, Ioannina, Greece
Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece

Background:

Systemic sclerosis (SSc) is characterized by vascular dysfunction (Raynaud's phenomenon, pulmonary hypertension), while patients often complain for dry symptoms. Eye examination provides information on both exocrine function and vascular integrity.

Objectives:

To seek for evidence of vascular dysfunction and sicca syndrome in a cohort of SSc patients.

Methods:

Patients with SSc, underwent ophthalmologic screening for dry eyes [Schirmer's test (ST), Break-up time (BUT), Rose Bengal stain (RBS)]. For comparison age and sex-matched healthy controls underwent similar testing. A patient or control was considered to have xerophthalmia, if at least 2 out of 3 tests were positive (ST<5 mm after 5 min, BUT <10 sec, RBS suggestive of dry keratopathy grade >3+). Patients were also surveyed for symptoms of xerostomia by means of a questionnaire and screened for antinuclear antibody (ANA) positivity and type. Those with strong evidence of Sjögren's syndrome (SS) underwent minor salivary gland biopsy. Finally, a random subset of patients underwent full ophthalmologic examination, including fundoscopy and fluorangiography.

Results:

Seventy-two SSc patients (65 females, 7 males, mean age 53.4±14.8 years) and 72 matched controls were screened for dry eyes. Twenty-four SSc patients were positive for xerophthalmia (33.3%), compared to only 11 controls (15.3%) (p<0.05). Further, 38 (52.3%) SSc patients reported xerostomia, while 21 (29.2%) complained for both dry eyes and mouth. Only 31 (43%) of SSc patients were completely free of dry symptoms and signs. Among patients with xerophthalmia 87.5% reported dry mouth, 95.8% were ANA-positive, 45.8% had anti-Scl-70, 33.3% had anticentromere, 8.3% anti-U1RNP, 25% anti-Ro and 12.5% anti-La antibodies. The corresponding values for SSc patients without dry eyes were 35.4% for dry mouth, 97.9% for ANA and 45.8, 18.8, 16.7, 35.4 and 2.1% for the ANA subtypes. Minor salivary gland biopsy was undertaken in 14 patients and was suggestive of SS in 9. Overall 9 (12.5%) patients had SS based on sicca symptoms, positive ophthalmologic tests and positive anti-Ro/La antibodies or biopsy, fulfilling the American-European consensus criteria for SS. Finally, 29 patients underwent anterior segment examination, fundoscopy and fluorangiography. Blepharitis was the most common clinical abnormality in 11 (37.9%) patients, followed by pinguecula in 6 (20.7%). In fundoscopy and fluorangiography retina was normal in 19 (65.5%) patients. The most common abnormality was maculopathy and pigmented epithelium impairment in 6 (20.7%) patients suggestive of vascular damage of the choroidal layer. Other findings were drusen in 3 (10.3%) patients, a peripheral aneurysm in one patient and a nevus in another. While all patients had Raynaud's phenomenon, no major retinal arterial abnormalities were detected.

Conclusion:

Objective signs of xerophthalmia are encountered in 1/3 of SSc patients and are usually associated with symptoms of dry mouth. Full-blown SSj may be found in 1 every 8 SSc patients. There seems to be a sparing of retinal arteries in contrast to choroidal vessels in SSc.

To cite this abstract, please use the following information:
Tsifetaki, Niki, Papagoras, Charalampos, Paschides, Contantinos A., Drosos, Alexandros A.; Findings in Ocular Examination of Patients with Systemic Sclerosis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1215
DOI: 10.1002/art.28981

Abstract Supplement

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