Hydroxychloroquine improves dry eye symptoms of patients with primary Sjogren’s syndrome

Springer Science and Business Media LLC - Tập 31 - Trang 1045-1049 - 2010
Sule Yavuz1, Esra Asfuroğlu2, Muge Bicakcigil3, Ebru Toker2
1Department of Rheumatology, Marmara University Medical School, Istanbul, Turkey
2Department of Ophthalmology, Marmara University Medical School, Istanbul, Turkey
3Department of Rheumatology, Yeditepe Medical School, Istanbul, Turkey

Tóm tắt

The objective of the study is to investigate the effect of hydroxychloroquine (HCQ) on subjective and objective parameters of dry eye in patients with primary Sjogren’s disease and to evaluate the association of tear fluid B-cell activating factor (BAFF) level with the response. Thirty-two patients with primary Sjogren’s disease were enrolled in this prospective study. All patients included in the study completed at least a 48-month run-in period of using hydroxychloroquine. Patients were then instructed to drop the treatment for 3 months. Baseline and post cessation of treatment (baseline and 3 months) evaluations included, subjective symptom scoring, fluorescein and lissamine green staining, Schirmer’s test, tear break-up time (BUT) and tear fluid BAFF assessments. Significant worsening was observed in, tear break up-time (TBUT) (7.9 ± 3.4 vs. 5.9 ± 2.9, P < 0.001) lissamine green of staining of the ocular surface (1.3 ± 0.9 vs. 1.8 ± 0.8, P < 0.01) and corneal fluorescein staining scores (2.2 ± 2.1 vs. 4.6 ± 3.3, P < 0.003) between on and off HCQ treatment, respectively. Similarly, gritty sensation and burning sensation were significantly changed at week 12 compared to baseline evaluation (1.18 ± 1.02 vs. 1.7 ± 1.05, P < 0.007 and 1.1 ± 1.0 vs. 1.6 ± 1.2, P < 0.0, respectively). Disease duration significantly correlated with baseline OSDI (r = 0.38, P < 0.04) and the average daily use of artificial tears (r = 0.36, P < 0.04). The mean BAFF levels were 0.8 ± 0.5 and 4.0 ± 0.7 ng/ml for baseline and week 12 evaluation, respectively (P < 0.0001). The results of this study suggest that HCQ may alleviate symptoms and signs of dry eye in pSS and decreases tear fluid BAFF levels.

Tài liệu tham khảo

Manoussakis MN, Moutsopoulos HM (2006) Sjögren’s syndrome. In: Rose NR, Mackay IR (eds) The autoimmune diseases, 4th edn. Elsevier, St Louis, pp 401–416 Venables PJ (2006) Management of patients presenting with Sjogren’s syndrome. Best Pract Res Clin Rheumatol 20(4):791–807 Mackay F, Groom JR, Tangye SG (2007) An important role for B-cell activation factor and B cells in the pathogenesis of Sjögren’s syndrome. Curr Opin Rheumatol 19(5):406–413 Groom J, Kalled SL, Cutler AH et al (2002) Association of BAFF/BLyS overexpression and altered B cell differentiation with Sjogren’s syndrome. J Clin Invest 109:59–68 Pers JO, Daridon C, Devauchelle V et al (2005) BAFF overexpression is associated with autoantibody production in autoimmune diseases. Ann N Y Acad Sci 1050:34–39 Daridon C, Devauchelle V, Hutin P et al (2007) Abberant expression of BAFF by B lymphocytes infiltrating the salivary glands of patients with primary Sjogren’s syndrome. Arthritis Rheum 56:1134–1144 Mariette X, Roux S, Zhang J et al (2003) The level of BLys (BAFF) correlates with the titre of autoantibodies in human Sjogren’s syndrome. Ann Rheum Dis 62:168–171 Fox RI, Dixon R, Guarrasi V, Krubel S (1996) Treatment of primary Sjogren’s syndrome with hydroxychloroquine; a retrospective, open-label study. Lupus 5:31–36 Kruize AA, Hene RJ, Kallenberg CG et al (1993) Hydroxychloroquine treatment for primary Sjogren’s syndrome; a two year, double blind cross over trial. Ann Rheum Dis 52:60–64 Vitali C, Bombardieri S, Moutsopoulos HM (2002) Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American–European consensus group. Ann Rheum Dis 61:554–558 Bron AJ, Evans VE, Smith JA (2003) Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea 22:640–650 Rihl M, Ulbricht K, Schmidt RE, Witte T (2009) Treatment of sicca symptoms with hydroxychloroquine in patients with Sjogren’s syndrome. Rheumatology 48(7):796–799 Dawson LJ, Caulfield VL, Stanbury JB et al (2005) Hydroxychloroquine therapy in patients with primary Sjogren’s syndrome may improve salivary gland hypofunction by inhibition of glandular cholinesterase. Rheumatology 44:449–455 Toker E, Asfuroglu E (2010) Corneal and conjunctival sensitivity in patients with dry eye: the effect of topical cyclosporine therapy. Cornea 29(2):133–140 Brignole F, Pisella PJ, Goldschild M et al (2000) Flow cytometric analysis of inflammatory markers in conjunctival epithelial cells of patients with dry eyes. Invest Ophthalmol Vis Sci 41:1356–1363 Stern ME, Gao J, Schwalb TA et al (2002) Conjunctival T-cell subpopulations in Sjögren’s and non-Sjögren’s patients with dry eye. Invest Ophthalmol Vis Sci 43:2609–2614 Pflugfelder SC, Jones D, Ji Z et al (1999) Altered cytokine balance in the tear fluid and conjunctiva of patients with Sjögren’s syndrome keratoconjunctivitis sicca. Curr Eye Res 19:201–211 Solomon A, Dursun D, Liu Z et al (2001) Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry eye disease. Invest Ophthalmol Vis Sci 42:2283–2292 Smith VA, Rishmawi H, Hussein H et al (2001) Tear film MMP accumulation and corneal disease. Br J Ophthalmol 85:147–153 Thien M, Phan TG, Gardam S et al (2004) Excess BAFF rescues self-reactive B cells from peripheral deletion and allows them to enter forbidden follicular and marginal zone niches. Immunity 20:785–798 Ittah M, Micelli-Richard C, Gottenberg JE et al (2006) B cell activating factor of the tumor necrosis factor family (BAFF) is expressed under stimulation by interferon in salivary gland epithelial cell in primary Sjogren’s syndrome. Arthritis Res Ther 8:R51 Candon S, Gottenberg JE, Bengoufa D, Chatenoud L, Mariette X (2009) Quantitative assessment of antibodies to ribonucleoproteins in primary Sjogren’s syndrome: correlation with B cell biomarkers and disease activity. Ann Rheum Dis 68(7):1208–1212 Toker E, Yavuz S, Direskeneli H (2004) Anti-Ro/SSAA and anti-La/SSB autoantibodies in the tear fluid of patients with Sjogren’s syndrome. Br J Ophthalmol 88:384–387 Yavuz S, Toker E, Bicakcigil M, Mumcu G, Cakir S (2006) Comparative analysis of autoantibodies against αfodrin in serum, tear fluid, and saliva from patients with Sjögren’s Syndrome. J Rheumatol 33:1289–1292