Look for dry eye in patients with mild RA.

Dry eye (keratoconjunctivitis sicca) is so common in patients with rheumatoid arthritis, even in those who don't have concomitant Sjogren's syndrome, that clinicians should always consider it a possibility in RA, said Dr. Miho Fujita and associates at Nippon Medical School, Tokyo.

"The term 'dry eye' is used to describe a variety of conditions with diverse origins that affect the tear film and/or the ocular surface," the investigators said. It is characterized by compromised tear dynamics and ocular surface abnormalities, and does not always produce obvious symptoms.

Noting that there have been few studies of the incidence of dry eye in RA patients, Dr. Fujita and associates examined a possible link between the two disorders in a prospective study of 72 RA patients (Am. J. Ophthalmol. 2005;140:808-13).

The patients were aged 30-85 years (mean age 64), and 7 had concomitant Sjogren's syndrome, a systemic autoimmune disorder that often causes dry eye. Patients who showed abnormalities of both tear dynamics and ocular surface were categorized as having definite dry eye, while those who showed only one of these types of abnormality were classified as having probable dry eye.

According to these criteria, 66 (92%) of the patients had probable or definite dry eye, including 59 (91%) of those who did not have Sjogren's syndrome. A total of 34 patients (47%) had definite dry eye.

Dry eye "should always be taken into consideration, regardless of the RA activity" and regardless of whether patients have Sjogren's syndrome, the researchers wrote.