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Corneal Involvement in Rheumatoid Arthritis: An In Vivo Confocal Study

¹From the 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; and ²Dipartimento di Reumatologia Ospedale Gaetano Pini, 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.