Sicca syndrome ‐ disease continnum. Anatomical, functional and systemic assessment

Abstract

PurposeTo evaluate objective findings in the ophthalmologic examination and search for patterns of association with the clinical and laboratory characteristics in patients with Sicca Syndrome (SiS).MethodsCross‐sectional study of 80 eyes of 80 patients with SiS divided into four groups. 20 patients with pSS for more than 10 years (group1), 20 patients with pSS for less than 2 years (group 2), 20 patients with SiS associated to undifferentiated connective tissue disease (UCTD) (group 3) and 20 patients with SiS without UCTD (group 4). Demographic, clinical and immunologic data were recorded. Ophthalmologic examinations included Schirmer test, break up time (BUT), Corneal Staining Score (CSS), tear meniscus evaluation in Anterior Segment – Optical Coherence Tomography (AS‐OCT) and corneal sub‐basal nerve plexus (CSNP) measurements with in vivo Confocal Microscopy (IVCM).ResultsGroup 1 had an early diagnosis when compared with group 2. Group 1 presented a higher frequency of positivity for anti‐SSA, anti‐SSB, Rheumatoid Factor and ANA titers compared to groups 2‐4 (p<0.05). Patients in group 1 presented more frequently systemic manifestations compared to groups 2‐4 (p<0.05). Sjogren Syndrome Activity Index (SSDAI) correlated positively with positive anti‐SSA (r=0.470, p<0.0005). Group 1 showed a higher CSS and a lower BUT, tear meniscus height and area compared to group 2 and 3 (p<0.005). CSNP's length and density were significantly smaller in group 1 compared to group 2 and 3 (p<0.05).ConclusionsCSNP's density and length, as well as tear meniscus area and height are smaller in advanced pSS compared to pSS with recent diagnostic and SiS‐UCTD. AS‐OCT and IVCM may be useful for risk stratification in SiS.