{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:16:22Z","timestamp":1792199782410,"version":"4.4.0"},"reference-count":39,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,15]],"date-time":"2023-01-15T00:00:00Z","timestamp":1673740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004700","name":"Taipei Medical University","doi-asserted-by":"publisher","award":["TMU110-AE1-B11"],"award-info":[{"award-number":["TMU110-AE1-B11"]}],"id":[{"id":"10.13039\/501100004700","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Rheumatoid arthritis is potentially connected to ocular disorders, such as corneal inflammation and lacrimal gland destruction. This study aimed to evaluate the risk of dry eye disease (DED) and corneal surface damage among patients with rheumatoid arthritis. In a nationwide cohort study, we utilized Taiwan\u2019s National Health Insurance research database and conducted propensity score matching to compare the risks of DED and corneal surface damage between patients with and without rheumatoid arthritis. Proportional hazards regression analyses were used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the outcomes of interest. The matching procedure generated 33,398 matched pairs with 501,377 person-years of follow-up for analyses. The incidence of DED was 23.14 and 10.25 per 1000 person-years in patients with and without rheumatoid arthritis, respectively. After adjusting for covariates, rheumatoid arthritis was significantly associated with DED (aHR: 2.03, 95% CI: 1.93\u20132.13, p &lt; 0.0001). The association was generally consistent across the subgroups of age, sex, use of systemic corticosteroids, and different comorbidity levels. In addition, patients with rheumatoid arthritis had a higher risk of corneal surface damage (aHR: 1.36, 95% CI: 1.21\u20131.51, p &lt; 0.0001) compared to control subjects. Other independent factors for corneal surface damage were age and sleeping disorders. Rheumatoid arthritis was associated with an increased risk of DED and corneal surface damage. Ophthalmological surveillance is required to prevent vision-threatening complications in this susceptible population.<\/jats:p>","DOI":"10.3390\/ijerph20021584","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T02:04:45Z","timestamp":1673834685000},"page":"1584","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Rheumatoid Arthritis Associated with Dry Eye Disease and Corneal Surface Damage: A Nationwide Matched Cohort Study"],"prefix":"10.3390","volume":"20","author":[{"given":"Shih-Chung","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Wun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Ming","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3279-4509","authenticated-orcid":false,"given":"Ying-Xiu","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8350-0232","authenticated-orcid":false,"given":"Tzeng-Ji","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan"},{"name":"Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu 31064, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiang-Ling","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0201-4380","authenticated-orcid":false,"given":"Yih-Giun","family":"Cherng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5210-6873","authenticated-orcid":false,"given":"Ying-Hsuan","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ajo.2019.01.026","article-title":"Estimated Prevalence and Incidence of Dry Eye Disease Based on Coding Analysis of a Large, All-age United States Health Care System","volume":"202","author":"Dana","year":"2019","journal-title":"Am. J. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Shanti, Y., Shehada, R., Bakkar, M.M., and Qaddumi, J. (2020). Prevalence and associated risk factors of dry eye disease in 16 northern West bank towns in Palestine: A cross-sectional study. BMC Ophthalmol., 20.","DOI":"10.1186\/s12886-019-1290-z"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1167\/iovs.04-0864","article-title":"Association between symptoms and signs of dry eye among an elderly Chinese population in Taiwan: The Shihpai Eye Study","volume":"46","author":"Lin","year":"2005","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kuo, Y.K., Lin, I.C., Chien, L.N., Lin, T.Y., How, Y.T., Chen, K.H., Dusting, G.J., and Tseng, C.L. (2019). Dry Eye Disease: A Review of Epidemiology in Taiwan, and its Clinical Treatment and Merits. J. Clin. Med., 8.","DOI":"10.3390\/jcm8081227"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II Epidemiology Report","volume":"15","author":"Stapleton","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"771352","DOI":"10.3389\/fmed.2021.771352","article-title":"Estimated Annual Economic Burden of Dry Eye Disease Based on a Multi-Center Analysis in China: A Retrospective Study","volume":"8","author":"Yang","year":"2021","journal-title":"Front. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e000709","DOI":"10.1136\/bmjophth-2021-000709","article-title":"Economic burden and loss of quality of life from dry eye disease in Canada","volume":"6","author":"Chan","year":"2021","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.ophtha.2017.07.010","article-title":"The Pathophysiology of Dry Eye Disease: What We Know and Future Directions for Research","volume":"124","author":"Pflugfelder","year":"2017","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jtos.2017.05.005","article-title":"TFOS DEWS II Introduction","volume":"15","author":"Nelson","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1136\/annrheumdis-2019-215920","article-title":"Global, regional and national burden of rheumatoid arthritis 1990\u20132017: A systematic analysis of the Global Burden of Disease study 2017","volume":"78","author":"Safiri","year":"2019","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s00296-012-2411-7","article-title":"Rheumatoid arthritis prevalence, incidence, and mortality rates: A nationwide population study in Taiwan","volume":"33","author":"Kuo","year":"2013","journal-title":"Rheumatol. Int."},{"key":"ref_13","first-page":"358","article-title":"Nationwide population-based epidemiologic study of rheumatoid arthritis in Taiwan","volume":"30","author":"Lai","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_14","first-page":"591","article-title":"Global epidemiology of rheumatoid arthritis","volume":"18","author":"Finckh","year":"2022","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7298026","DOI":"10.1155\/2017\/7298026","article-title":"Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment","volume":"2017","author":"Cao","year":"2017","journal-title":"J. Ophthalmol."},{"key":"ref_16","first-page":"543","article-title":"Peripheral ulcerative keratitis due to systemic diseases","volume":"33","author":"Sura","year":"2022","journal-title":"Curr. Opin Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.ajo.2005.05.025","article-title":"Correlation between dry eye and rheumatoid arthritis activity","volume":"140","author":"Fujita","year":"2005","journal-title":"Am. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"318","DOI":"10.12659\/AJCR.883998","article-title":"Peripheral corneal ulceration associated with rheumatoid arthritis","volume":"14","author":"Karampatakis","year":"2013","journal-title":"Am. J. Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"523","DOI":"10.12659\/AJCR.891127","article-title":"Rheumatoid arthritis-associated corneal ulceration with superimposed infection by methicillin-resistant Staphylococcus aureus: A complicated type of corneal melt","volume":"15","author":"Singh","year":"2014","journal-title":"Am. J. Case Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/ICO.0000000000000437","article-title":"Ocular Inflammation in the Setting of Concomitant Systemic Autoimmune Conditions in an Older Male Population","volume":"34","author":"Levitt","year":"2015","journal-title":"Cornea"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/25785826.2020.1729597","article-title":"Dry eye in rheumatoid arthritis: Relation to disease activity","volume":"43","author":"Hassan","year":"2020","journal-title":"Immunol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Bench\u00e9rifa, S., Amine, B., El Binoune, I., Rostom, S., and Bahiri, R. (2020). Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy. BMC Rheumatol., 4.","DOI":"10.1186\/s41927-019-0108-1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5768679","DOI":"10.1155\/2020\/5768679","article-title":"Study of Factors Influencing Dry Eye in Rheumatoid Arthritis","volume":"2020","author":"Ma","year":"2020","journal-title":"J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.jaad.2021.10.045","article-title":"Association between alopecia areata and retinal diseases: A nationwide population-based cohort study","volume":"87","author":"Ting","year":"2022","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chou, Y.J., Tai, Y.H., Dai, Y.X., Lee, D.D., Chang, Y.T., Chen, T.J., and Chen, M.H. (2022). Obsessive-compulsive disorder and the associated risk of autoimmune skin diseases: A nationwide population-based cohort study. CNS Spectr., 1\u20137.","DOI":"10.1017\/S1092852921000973"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1159\/000514581","article-title":"Bidirectional association between psoriasis and atopic dermatitis: A nationwide population-based cohort study","volume":"237","author":"Dai","year":"2021","journal-title":"Dermatology"},{"key":"ref_28","unstructured":"National Health Insurance Research Database (2022, October 28). Data Subsets. Available online: https:\/\/nhird.nhri.org.tw\/en\/Data_Subsets.html."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.ajo.2021.03.013","article-title":"The Risks of Corneal Surface Damage in Aqueous-Deficient Dry Eye Disease: A 17-Year Population-Based Study in Taiwan","volume":"227","author":"Hung","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Li, B., Evans, D., Faris, P., Dean, S., and Quan, H. (2008). Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. BMC Health Serv. Res., 8.","DOI":"10.1186\/1472-6963-8-12"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/sim.6004","article-title":"A comparison of 12 algorithms for matching on the propensity score","volume":"33","author":"Austin","year":"2014","journal-title":"Stat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3899\/jrheum.190768","article-title":"Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis","volume":"48","author":"Turk","year":"2021","journal-title":"J. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/2331205X.2016.1243771","article-title":"A review of the ocular manifestations of rheumatoid arthritis","volume":"3","author":"Lamba","year":"2016","journal-title":"Cogent. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.rdc.2007.08.002","article-title":"Scleritis and peripheral ulcerative keratitis","volume":"33","author":"Galor","year":"2007","journal-title":"Rheum. Dis. Clin. North Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/nrrheum.2014.85","article-title":"The eye: A window of opportunity in rheumatoid arthritis?","volume":"10","author":"Tong","year":"2014","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1177\/1753425912471692","article-title":"Inflammation in dry eye associated with rheumatoid arthritis: Cytokine and in vivo confocal microscopy study","volume":"19","author":"Villani","year":"2013","journal-title":"Innate. Immun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s40123-020-00308-z","article-title":"Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary Care Family Physicians","volume":"9","author":"Verjee","year":"2020","journal-title":"Ophthalmol. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1002\/art.41752","article-title":"2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis","volume":"73","author":"Fraenkel","year":"2021","journal-title":"Arthritis Rheumatol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1584\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:06:43Z","timestamp":1760119603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,15]]},"references-count":39,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20021584"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20021584","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,15]]}}}