Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease frequently associated with extra-articular manifestations, including dry eye syndrome (DES). Chronic inflammation and immune dysregulation in RA contribute to the development and progression of DES, affecting up to 30% of RA patients. This study investigates the relationship between RA activity, DMARD therapy, and DES severity, focusing on how systemic treatment influences inflammatory and ocular parameters.

Objectives: Assess the impact of conventional synthetic DMARDs (csDMARDs) and biological DMARDs (bDMARDs) on DES severity in RA patients. Evaluate correlations between RA disease activity and DES severity. Analyze changes in inflammatory markers in RA patients with DES undergoing DMARD therapy.

Methods: Seventy-five RA patients with DES (150 eyes) aged 40–75 years and with disease durations ranging from days to 20 years participated in this study. Patients were divided into two groups based on their RA treatment: csDMARDs (40 patients) and bDMARDs (35 patients). Disease activity was assessed using DAS28-CRP (mean baseline score: 2.8 ± 0.33, indicating mild-to-moderate activity). DES severity was classified per DEWS 2007 guidelines. Comprehensive ophthalmologic evaluations included Schirmer’s test, Ocular Surface Disease Index (OSDI) scores, conjunctival staining, tear film stability (Norn’s test), and tear osmolarity.

Results: DMARD therapy significantly influenced DES severity. Patients treated with bDMARDs showed predominantly mild DES, while those on csDMARDs had more moderate-to-severe presentations. After six months of treatment, OSDI scores improved significantly in both groups, with greater improvements in the bDMARD group. Severe DES improved from a baseline OSDI score of 75.0 ± 7.4 to 41.7 ± 7.6 (p<0.05) in the csDMARD group and from 69.4 ± 6.2 to 37.5 ± 5.4 (p<0.05) in the bDMARD group. Basal tear production improved across all severity levels. Schirmer’s test results showed a more substantial improvement in patients treated with bDMARDs, particularly those with moderate and severe DES. Tear osmolarity values decreased significantly, with bDMARD-treated patients achieving lower osmolarity levels compared to those on csDMARDs. In patients with severe DES, tear osmolarity decreased from 341.0 ± 4.6 to 315.0 ± 4.6 mOsm/L (p<0.05) in the csDMARD group and from 338.0 ± 4.6 to 312.0 ± 4.9 mOsm/L (p<0.05) in the bDMARD group. RA disease activity, measured by DAS28-CRP, decreased significantly in both groups, correlating with reductions in DES severity (p=0.00275).

Conclusion: Patients on bDMARDs experienced milder DES compared to those on csDMARDs, demonstrating the systemic anti-inflammatory benefits of biologics. Both DMARD regimens effectively reduced DES severity, with bDMARDs providing superior outcomes in systemic and ocular inflammation control. Effective management of systemic inflammation in RA can significantly improve DES, enhancing patient quality of life. This study highlights the critical role of systemic therapy in addressing extra-articular RA manifestations, emphasizing the importance of controlling inflammation to manage DES effectively.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.