[2006] [THU0217] MODIFICATION OF LACRIMAL FILM IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH ETANERCEPT

F. Ceccarelli¹, R. Priori ¹ , L. Magrini ¹ , S. Rezai ¹ , M. Pinca ² , M. Marino ² , P. Pivetti-Pezzi ² , G. Valesini ^{1 1}Division of Rheumatology, ²Division of Ophthalmology, University of Rome La Sapienza, Rome, Italy

Background: Keratoconjunctivitis sicca (KCS) is one of the hallmark of Sjögren's syndrome (SS) but it is commonly seen, even in the absence of a secondary SS, in patients suffering from systemic autoimmune diseases such as systemic lupus erythematosus, scleroderma, thyroiditis, rheumatoid arthritis (RA) where a clear correlation with disease activity has not been found. Etanercept is a well established therapy for RA and psoriasic arthritis (PsA) where it is able to suppress the clinical manifestations, improve patient mobility and retard the radiographic progression of joint erosions. The spectrum of its indications is rapidly expanding however its use in Sjögren's syndrome (SS) has brought unsatisfactory results.
Objectives: The purpose of this study was to evaluate the modifications of lacrimal film in patients with RA and PsA during treatment with Etanercept and to correlate the change, if any, with disease activity.
Methods: Criteria for patients selection were: an active joint disease not responsive to at least one traditional DMARDs, symptoms of dry eye (assessed by the questionnaire included in SS classification criteria) and/or objective signs of dry eye (assessed by Schirmer I test, Break Up Time and fluorescein staining), exclusion of other known causes of dry eye such as the concomitant use of anticholinergic drug, a previous positive history for ocular diseases. Secondary SS according to Euro-America criteria was also an exclusion criteria. 10 consecutive patients were enrolled: 9 with RA (M/F 0/9; mean age= 53.3y; mean disease duration= 12.3 y), and 1 with PsA without psoriasic lesions (M/F 1/0; mean age= 42y; mean disease duration =6.6 y).
Before beginning Etanercept (25 mg/sc twice a week) and after three months of therapy, disease activity was assessed with DAS 28 and HAQ; each patients answered to the questionnaire disegned to assess ocular symptoms: a positive answer to at least one question was considerated indicative of ocular discomfort. Schirmer I test, Break Up Time (BUT) and fluorescein staining was performed as well.
Results: At the time of enrollment 4/10 patients (40%) had ocular dryness, in 100% of the patients the tear break-up time (BUT) was < 5 seconds (83%), in 9/10 patients (90%) the Schirmer test resulted <10 mm/5 min, 3/10 patients (30%) showed ocular surface abnormalities identified by positive fluorescein staining. BUT and Shirmer's test improved in 17/20 eye (85%) and in 14/18 eye (70%) respectively. Ocular surface abnormalities disappeared in both eyes of the patients with basal alterations. The mean decrease in HAQ score was 0,7 (0-1) the mean decrease in DAS 28 was 0,94 (0-3,1). In three patients DAS 28 increased while dry eye improved.
Conclusion: Etanercept improved ocular dryness in patients with RA and dry eyes without secondary SS. As previous studies have failed to demonstrate any effect of this drug in SS it is possible to hypotesize that the physiopathologic mechanism of dry eye is different in SS patients and non-SS patients. In this group of patients a secondary SS was a criteria of exclusion and dry eye seemed to represents one more feature in the spectrum of RA which severity has been positively affected by Etanercept also in those patients not yet adequately responsive to the drug.

Rheumatic arthritis treatment biologics