Corneal involvement in rheumatoid arthritis: An in vivo confocal study
Corneal involvement in rheumatoid arthritis: An in vivo confocal study
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DOI：
10.1167/iovs.07-0893
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发表时间：
2008-02-01
影响因子：
4.4
通讯作者：
Ratiglia, Roberto
中科院分区：
文献类型：
--
作者：
Villani, Edoardo;Galimberti, Daniela;Ratiglia, Roberto
目的。分析伴有或不伴有继发性干燥综合征（SSII）的类风湿关节炎（RA）患者角膜细胞和神经的体内形态，探讨角膜改变与RA活动的相关性。研究了50名RA患者和30名年龄和性别匹配的对照组。根据欧美共识组（American-European Consensus Group）标准诊断SSII，用Lansbury指数（LI）评估RA活动性。用共聚焦显微镜观察角膜厚度、上皮细胞和间质细胞的数量以及角膜细胞的高反射率。此外，还评估了基底下神经丛神经纤维的数量、弯曲度和反射率以及珠状结构的存在。16%的类风湿性关节炎患者也有SSII。在SSII组和非SSII组之间，在LI或临床和共聚焦变量中没有发现显著差异。除神经反射率外，RA患者与对照组在所有研究变量上均存在显著差异。在伴有或不伴有SSII的RA患者中，LI与珠状结构的数量和高反射性活化角化细胞的数量显著相关。RA患者的共聚焦显微镜显示角膜细胞和神经的一些变化。珠状形成的数量和活化的角化细胞的数量可以解释为眼表疾病活动的共聚焦迹象。这些与全身性疾病活动性指数LI的相关性可能为RA患者干眼的发病机制提供见解。
PURPOSE. To analyze the in vivo morphology of corneal cells and nerves in patients with rheumatoid arthritis (RA), with or without secondary Sjogren'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.