Corneal Changes linked to severity of disease activity in rheumatoid arthritis patients

A study found that patients with Rheumatoid arthritis had reduced corneal sensitivity, a loss of corneal nerve fibers, and an increase in Langerhans cells, which were all linked to the severity of their disease activity, Says Dr Gulfidan Bitirgen and colleagues in their recent study published in Eye.

This cross-sectional study included 50 RA patients and 35 healthy controls. It was conducted at a university hospital. It assessed disease activity with a 28-Joint Disease Activity Score and erythrocyte sedimentation rate or DAS28-ESR and central corneal sensitivity with a Cochet-Bonnet contact corneal esthesiometer. Corneal nerve fibre density, branch density, length, and Langerhans cell density were measured using a confocal microscope.

This study employed corneal confocal microscopy to determine if there is any indication of small nerve fibre damage and immune cell activation in individuals with rheumatoid arthritis (RA).

Key findings from the study are:

• Corneal sensitivity, corneal nerve fibre density (CNFD), nerve branch density (CNBD) and nerve fibre length (CNFL) were lower, and mature and immature Langerhans cell (LC) densities were higher in RA patients than in control subjects.
• CNFD and CNFL were lower in patients with moderate to high (DAS28-ESR > 3.2) compared to mild (DAS28-ESR ≤ 3.2) disease activity.
• DAS28-ESR score correlated with CNFD (r = −0.425), CNBD (ρ = −0.362), CNFL (r = −0.464), total LC density (ρ = 0.362) and immature LC density (ρ = 0.343).

Our study demonstrated reduced corneal sensitivity, corneal nerve fibre loss and increased Langerhans cells, which were associated with the severity of disease activity in rheumatoid arthritis patients.

The work was supported by The Scientific Research Coordination Center of Necmettin Erbakan, as acknowledged.

Reference:

Bitirgen, G., Kucuk, A., Ergun, M.C. et al. Corneal nerve loss and increased Langerhans cells are associated with disease severity in patients with rheumatoid arthritis. Eye 37, 2950–2955 (2023). https://doi.org/10.1038/s41433-023-02447-6