Prevalence, risk, and risk factors for oral and ocular dryness with particular emphasis on rheumatoid arthritis

Objective. To determine, primarily in rheumatoid arthritis (RA), the prevalence, relative risk, and risk factors for oral and ocular dryness. Methods. We studied self-reported persistent ocular and oral dryness (PD) present in 2 consecutive observations, and sporadic dryness (SD) present in 1 of 2 consecutive observations, during semiannual assessments in 9921 patients with RA and in 2851 with a noninflammatory rheumatic disorder (NIRD) (not fibromyalgia; FM). We also evaluated prevalence in 2867 patients with FM. Results. In RA, PD was noted in 11.6% and SD in 17.5%. Compared with NIRD, the age and sex adjusted relative risk (RR) for PD was 1.34 (95% CI 1.17-1.51) and the severity and treatment adjusted RR was 1.46 (95% CI 1.26-1.6). The adjusted RR for FM compared with RA and NIRD was 2.02 (95% CI 1.85-2.20). Dryness prevalence increased 10% to 13% every 10 years, and was associated with therapy. The treatment attributable risk was 27.5%. Fatigue and body pain (Symptom Intensity Scale) was more strongly associated with dryness than was any other clinical scale, including Health Assessment Questionnaire, pain, and Medical Outcomes Study Short Form-36 Health Survey. SD was associated with a covariate adjusted decrease in quality of life of 0.020 (95% CI 0.012-0.029) utility units. Conclusion. Dryness is increased in RA and is contributed to by severity and therapy. The combination of body pain and fatigue is the strongest clinical correlate of dryness, and is independent of diagnosis of FM. Any factor that increases illness severity or distress results in an increase in dryness.