Lupus retinopathy: a marker of active systemic lupus erythematosus
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Retinopathy in the context of systemic lupus erythematosus (SLE) is associated with severe disease and poorer prognosis. We studied retinopathy in our cohort of Indian lupus patients. Four hundred and thirty-seven patients fulfilling the Systemic Lupus International Collaborating Clinics-American College of Rheumatology-2012 criteria, attending the department of Clinical Immunology were enrolled under this cross-sectional study. A comprehensive clinical (including ophthalmological) examination and immunological profile were performed. Retinopathy was defined if cotton-wool spots, haemorrhages, vasculitis, retinal detachment or optic disc changes as papilledema, optic atrophy were present. Disease activity was assessed using SLE disease activity index (SLEDAI). Mean age of participants was 28.06 ± 9.7 years (93.1% females); median disease duration 12 months (Interquartile range—IQR 6.36). Forty-five (10.3%) had SLE associated retinopathy. Autoimmune haemolytic anaemia [31.1 vs 14.5%, p value 0.004, odd’s ratio—OR (95% confidence interval—CI) 2.65 (1.33–5.29)], serositis [33.3 vs 18.9%, p value 0.023, OR (CI) 2.14 (1.11–4.10)], lupus nephritis [62.2 vs 40.8%, p value 0.006, OR (CI) 2.38 (1.26–4.50)], seizures [28.9 vs 12.8%, p value 0.004, OR (CI) 2.77 (1.36–5.65)] and median SLEDAI score (24 vs 12, p < 0.01) were significantly higher in those with retinopathy. On adjusted binary logistic regression, autoimmune hemolytic anemia, lupus nephritis and presence of antibodies to Smith antigen were predictors for retinopathy. Retinopathy is common in SLE, a marker of active disease with frequent renal involvement and should be screened for in all patients with lupus.
KeywordsSystemic lupus erythematosus Disease activity Retinopathy Neuropsychiatric lupus Lupus nephritis Seizures
Anti cardiolipin antibody
Auto immune hemolytic anemia
Anti-mitochondrial M2 antibody
- Anti-β2 GP1
Anti-β2 glycoprotein 1
- C3, C4
Complement component 3 and 4
Centromere protein B
Central retinal artery occlusion
Central retinal vein occlusion
Dilute Russel viper venom test
Double stranded deoxyribonucleic acid
Extractable nuclear antigen
Proliferating cell nuclear antigen
Systemic lupus erythematosus
Systemic lupus erythematosus disease activity index
Systemic Lupus International Collaborating Clinics-American College of Rheumatology
Statistical package for the social sciences
Sjogren’s syndrome related antigen A
Sjogren’s syndrome related antigen B
- U1 RNP
The conception and design of the study—GS, DPM, RB, VSN. Acquisition of data—GS, RB, PB, SKC. Analysis and interpretation of data—GS, CKG, DPM, RB, GK, VSN. Drafting the article—GS, CKG, PB, SKC, GK. Revising it critically for important intellectual content—DPM, RB, VSN. Final approval of the version to be submitted—GS, CKG, DPM, RB, PB, SKC, GK, VSN. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved—GS, CKG, DPM, RB, PB, SKC, GK, VSN.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
Gaurav Seth declares that he has no conflict of interest. Chengappa KG declares that he has no conflict of interest. Durga Prasanna Misra declares that he has no conflict of interest. Ramesh Babu declares that he has no conflict of interest. Pooja Belani declares that she has no conflict of interest. Shanoj KC declares that he has no conflict of interest. Gunjan Kumar declares that she has no conflict of interest. Vir Singh Negi declares that he has no conflict of interest.
Approved by the Ethical Review board of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Informed consent was obtained from all individual participants included in the study.