WAILEA, Hawaii — In dry eye patients who are not improving, Cynthia A. Matossian, MD, recommends ordering testing for Sjögren’s syndrome.
“You’ll be surprised at the percentage of positive patients,” Matossian said at Hawaiian Eye 2018.
“We see these patients in our offices because they come to us complaining of dry eye, but what’s happening is they aren’t complaining about dry eye in primary care, so no one is connecting the dots,” she said.
There is about a 3 year to 10 year lag time from early symptoms to final diagnosis in Sjögren’s syndrome. These patients are going from doctor to doctor and eye care provider to eye care provider; they are very frustrated and under a lot of discomfort, she added.
There is a 19-fold increased risk of Non-Hodgkin Lymphoma in these patients.
Matossian designed a retrospective study to evaluate the percentage of patients positive for Sjögren’s biomarkers.
The traditional biomarkers in Sjogren’s are SS-A (Ro) and SS-B (La). New, novel biomarkers include: salivary protein 1, carbonic anhydrase VI and parotid specific protein, she said.
A total of 52% of patients were positive for one or more biomarker. “I was stunned by this data,” Matossian said.
Thirty-two percent of patients were positive for novel biomarkers, 3% were positive for both novel and traditional, and only 1% were positive for traditional SS-A and SS-B.
“What was also interesting was that 9% were positive for antinuclear antibody and 12% were positive for rheumatoid factor, so there is a lot of overlap with connective tissue diseases,” she said.
“This tells you how important it is to have a very low threshold of patients with dry eye disease who are just not getting better on the traditional treatment regimens that we put them on, they aren’t improving. After ruling out noncompliance, order the blood test,” she continued.
Matossian suggests working with rheumatology. “Many [rheumatologists] do not understand the novel biomarkers. As a team along with primary care, we can be on the lookout for Non-Hodgkin Lymphoma,” she concluded. – by Abigail Sutton
Matossian C. Sjögren’s Syndrome: Detection of early and late antibodies in dry eye patients. Presented at: Hawaiian Eye 2018; Jan. 13-19, 2018; Wailea, Hawaii.
Disclosure: Matossian reports that she is a paid consultant to and receives research support from Bausch + Lomb, the maker of the Sjö test.