Innate Immun. 2013;19(4):348-54.

In vivo confocal microscopic evaluation of corneal Langerhans cell density, and distribution and evaluation of dry eye in rheumatoid arthritis.

László Marsovszky1 MD, Miklós D. Resch1 MD Ph.D, János Németh1 MD Ph.D DSc,Gergely Toldi3 MD, Erzsébet Medgyesi2,László Kovács2 MD Ph.D, Attila Balog2 MD Ph.D

1Department of Ophthalmology, Semmelweis University, Budapest, Tömő u. 25–29. H-1083, Hungary

2Department of Rheumatology, Albert Szent-Györgyi Health Center, University of Szeged, Kálvária sgt. 57., H-6027, Hungary

3First Department of Pediatrics, Semmelweis University, Budapest, Bókay u. 53-54., H-1083, Hungary


Corresponding author:

Attila Balog, MD, Ph.D

Department of Rheumatology, Faculty of Medicine, Albert Szent-Györgyi Health Center, University of Szeged

Kálvária sgt. 57., H-6725, Szeged, Hungary




Corneal Langerhans cell (LC) offers the opportunity to gain insight into the activity of the innate immunity. We examined the density and the distribution of LCs and compared the results with dry-eye parameters in rheumatoid arthritis (RA). 52 RA patients with various degree of disease activity and 24 healthy subjects were enrolled. Peripheral and central LC number and morphology were assessed with in vivo laser confocal microscopy. In addition, ocular surface disease index (OSDI), lid parallel conjunctival folds, Schirmer test, and tear break up time (TBUT) were evaluated. The prevalence of central and peripheral LC and the central LC morphology values (LCM) were higher than normal in RA. Within the RA group, LC prevalence and morphology were not affected by disease activity. However, patients on anti-TNF or glucocorticosteroid (GCS) therapy exhibited normal LCM and normal central and peripheral LC density. OSDI was higher and TBUT was lower than normal in RA. The alteration of LC in RA suggest an active inflammatory process in the cornea which may reflect an increased activation state of the innate immune system even in inactive stage of RA and without ocular symptoms. The results also indicate ocular effects of GCS therapy in RA.




Figure 1 Confocal microscopic image of the corneal centre and the periphery in the control group (1/a,c) and in the patient group (1/b,d). Arrows indicating Langerhans cells in different maturation states.

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