Singapore Eye Research Institute, Singapore National Eye Center, 11 Third Hospital Avenue, 168751, Singapore.
Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, 169608, Singapore.
Nat Rev Rheumatol. 2014 Sep;10(9):552-60. doi: 10.1038/nrrheum.2014.85. Epub 2014 Jun 10.
Rheumatoid arthritis (RA), the most common autoimmune disorder associated with dry eye syndrome, is also associated with sight-threatening ocular diseases such as peripheral ulcerative keratitis, scleritis and corneal melts. Tissue damage on the ocular surface of patients with RA is autoimmune-mediated. Findings from patients with dry eye have implicated defects in innate immunity (Toll-like receptors, S100A and resident antigen-presenting cells), cytokines, chemokines and T helper (TH)-cell subsets (including TH1 and TH17) in disease pathogenesis. Some of these features are probably important in dry eye related to RA, which can occur at a different time from articular disease and is more clinically severe than idiopathic dry eye. Ocular surface immune factors can be influenced by the systemic immune landscape. Depending on the severity of ocular inflammation in RA, treatment can include ciclosporin, topical corticosteroids, tacrolimus, autologous serum and systemic immunosuppression. Tissue damage is treated by inhibiting matrix metalloproteinases. Potential therapeutic strategies benefit from an improved understanding of ocular surface immunology, and include targeting of T-cell subsets, B-cell signalling or cytokines.
类风湿关节炎（RA）是最常见的与干眼综合征相关的自身免疫性疾病，也与威胁视力的眼部疾病有关，如边缘溃疡性角膜炎、巩膜炎和角膜溶解。RA 患者的眼表组织损伤是由自身免疫介导的。干眼患者的研究结果表明，先天免疫（Toll 样受体、S100A 和常驻抗原呈递细胞）、细胞因子、趋化因子和辅助性 T 细胞亚群（包括 TH1 和 TH17）缺陷在疾病发病机制中起作用。这些特征中的一些可能与 RA 相关的干眼有关，RA 与关节疾病的发生时间不同，且比特发性干眼更具临床严重性。眼表免疫因子可受全身免疫状况的影响。根据 RA 中眼部炎症的严重程度，治疗方法包括环孢素、局部皮质类固醇、他克莫司、自体血清和全身免疫抑制。通过抑制基质金属蛋白酶来治疗组织损伤。对眼表免疫学的深入了解有助于制定潜在的治疗策略，包括针对 T 细胞亚群、B 细胞信号或细胞因子。
