title: Serologic Markers Are Associated With Ocular Staining Score in Primary Sjögren Syndrome.
abstract: OBJECTIVE
  To investigate the relationship between serologic markers and dry eye severity in subjects with primary Sjögren syndrome (SS).
  
  
  METHODS
  This study evaluated 64 patients diagnosed with primary SS according to the 2012 Sjögren's International Collaborative Clinical Alliance (SICCA) classification criteria. Serum anti-Ro/SSA, anti-La/SSB, rheumatoid factor (RF), and antinuclear antibody (ANA) levels, Ocular Surface Disease Index (OSDI), Schirmer I test values, tear film breakup time, and SICCA ocular staining score (OSS) were determined.
  
  
  RESULTS
  The conjunctival staining scores were 3.3 ± 1.9, 3.6 ± 2.0, 3.4 ± 1.9, and 3.5 ± 1.9 in the positive anti-Ro (≥25 EU), positive anti-La (≥25 EU), positive RF (≥20 IU/mL), and positive ANA (≥1:320) group, respectively. Subjects with positive anti-Ro, anti-La, RF, or ANA had significantly higher conjunctival staining scores compared with those with negative levels (P < 0.05). The total OSS in the positive ANA group was 5.5 ± 3.0, which was significantly higher than the total OSS (3.4 ± 2.1) in the negative ANA group (P = 0.005). Serum RF and ANA levels had strong correlations with conjunctival staining scores and the total OSS but not with corneal staining scores (r = 0.53, P < 0.001 and r = 0.382, P = 0.002). Other ocular parameters (OSDI, Schirmer I test values, and tear film breakup time) did not differ by the serologic marker level. Interestingly, the OSDI was positively correlated with the corneal staining score and total OSS (r = 0.646, P < 0.001 and r = 0.476, P < 0.001).
  
  
  CONCLUSIONS
  Serum RF and ANA levels are associated with conjunctival staining scores and the total OSS according to the SICCA OSS in primary SS.
authors.affiliation: *Department of Ophthalmology and Visual Science, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; †Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea; ‡Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea; and §Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung A
authors.initials: SA
authors.lastname: Lim
authors.forename: Sangmin
authors.initials: S
authors.lastname: Nam
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kwok
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Park
authors.forename: So-Hyang
authors.initials: SH
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000097:blood* / Q000175:diagnosis; D013194:Staining and Labeling / Q000379:methods; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D015415:Biomarkers; C035356:SS-A antibodies; C035357:SS-B antibodies; D012217:Rheumatoid Factor