Dry eye disease may precede the diagnosis of autoimmune disease by several years and varies in frequency across autoimmune conditions, according to a population-based cohort study from Taiwan. The findings also suggest that certain autoimmune diseases may be associated with a greater risk of ocular surface complications.

In the study, published in JAMA Network Open, Nan-Ni Chen, MD, of Chang Gung Memorial Hospital, Chiayi, Taiwan, and colleagues analyzed national insurance data from 2008 to 2021 to evaluate the prevalence, timing of onset, and ocular surface damage associated with dry eye disease (DED) across 10 major autoimmune diseases. The analysis included 67,264 patients newly diagnosed with autoimmune disease between 2011 and 2020 identified from the Taiwan National Health Insurance Research Database, which covers more than 99% of the population.

Rheumatoid arthritis and Sjögren’s syndrome were the most common autoimmune diagnoses, accounting for 37% and 34% of cases, respectively. The prevalence of DED was varied by condition, ranging from 23% in patients with Crohn’s disease to 81% in those with Sjögren’s syndrome.

Among individual diseases, DED affected:

• 81% of patients with Sjögren’s syndrome

• 39% with rheumatoid arthritis (RA)

• 38% with systemic lupus erythematosus

• 36% with polymyositis

• 35% with systemic sclerosis

• 31% with pemphigus

• 31% with dermatopolymyositis

• 30% with ulcerative colitis

• 28% with vasculitis

• 23% with Crohn’s disease.

Across all autoimmune diseases examined, DED was more common in females than males.

Ocular surface complications were also documented. Keratitis occurred most frequently in patients with Sjögren’s syndrome (31%) and was also reported in patients with vasculitis (27%), systemic lupus erythematosus (24%), and RA (22%). Corneal ulcers occurred in approximately 3% of patients across these conditions, with the highest proportion among those with Sjögren’s syndrome.

When examining progression among patients with DED, differences in progression to keratitis or ulcers were statistically significant. Patients with vasculitis had the highest proportions, with about 28% of patients developing keratitis and 11% developing ulcers.

Across all autoimmune conditions studied, DED generally preceded systemic diagnosis by approximately 3 years. DED prevalence also increased following autoimmune disease diagnosis across most conditions.Patients with vs without DED were also diagnosed with autoimmune disease at older ages. The researchers reported the largest age difference in Crohn’s disease, where patients with DED were diagnosed at an average age of 54 years compared with 40 years in those without DED, “underscoring a temporal and clinical association between DED and autoimmune disease onset.”

The researchers wrote that “ocular surface involvement may represent an early systemic manifestation and provide an opportunity for earlier clinical evaluation, despite possible diagnostic delay.”

They also noted several limitations. The administrative database lacked detailed ophthalmic examinations, symptom severity measures, biomarker data, and treatment information, limiting assessment of disease activity and treatment effects. In addition, disease severity definitions based on keratitis or corneal ulceration may have included cases attributable to causes other than DED.

Despite these constraints, the researchers concluded that the findings “highlight the importance of early recognition and proactive management of DED to reduce ocular morbidity in autoimmune populations.”

Disclosure: The researchers reported no conflicts of interest. 

Source: JAMA Network Open