Abstract
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.
Abbreviations
- ACLA:
-
Anti cardiolipin antibody
- AIHA:
-
Auto immune hemolytic anemia
- AMA-M2:
-
Anti-mitochondrial M2 antibody
- Anti-β2 GP1:
-
Anti-β2 glycoprotein 1
- C3, C4:
-
Complement component 3 and 4
- CENP-B:
-
Centromere protein B
- CRAO:
-
Central retinal artery occlusion
- CRVO:
-
Central retinal vein occlusion
- DRVVT:
-
Dilute Russel viper venom test
- dsDNA:
-
Double stranded deoxyribonucleic acid
- ENA:
-
Extractable nuclear antigen
- IQR:
-
Inter-quartile range
- LAC:
-
Lupus anticoagulant
- NPSLE:
-
Neuropsychiatric SLE
- PCNA:
-
Proliferating cell nuclear antigen
- SLE:
-
Systemic lupus erythematosus
- SLEDAI:
-
Systemic lupus erythematosus disease activity index
- SLICC-ACR:
-
Systemic Lupus International Collaborating Clinics-American College of Rheumatology
- Sm:
-
Smith
- SPSS:
-
Statistical package for the social sciences
- SS-A:
-
Sjogren’s syndrome related antigen A
- SS-B:
-
Sjogren’s syndrome related antigen B
- U1 RNP:
-
U1 ribonucleoprotein
References
Preble JM, Shilpa-Archa S, Foster CS (2015) Ocular involvement in systemic lupus erythematosus. Curr Opin Ophthalmol 26:540–545. https://doi.org/10.1097/ICU.0000000000000209
Stafford-Brady FJ, Urowitz MB, Gladman DD, Easterbrook M (1988) Lupus retinopathy. Patterns, associations, and prognosis. Arthritis Rheum 31:1105–1110
Giorgi D, Pace F, Giorgi A, Bonomo L, Gabrieli CB (1999) Retinopathy in systemic lupus erythematosus: pathogenesis and approach to therapy. Hum Immunol 60:688–696. https://doi.org/10.1016/S0198-8859(99)00035-X
D’Cruz D (1998) Vasculitis in systemic lupus erythematosus. Lupus 7:270–274
Rosenbaum JT, Trune DR, Barkhuizen A, Lim L (2013) Ocular, aural and oral manifestations. In: Wallace DJ, Hahn BH (eds) Dubois’s lupus erythematosus and related syndromes, 8th edn. Elsevier Saunders, Philadelphia, pp 393–400
Kharel R, Shah DN, Singh D (2016) Role of lupus retinopathy in systemic lupus erythematosus. J Ophthalmic Inflamm Infect 6:15. https://doi.org/10.1186/s12348-016-0081-4
Chua J, Lim CXY, Wong TY, Sabanayagam C (2018) Diabetic retinopathy in the Asia-Pacific. Asia Pac J Ophthalmol (Phila) 7:3–16. https://doi.org/10.22608/apo.2017511
Malaviya AN, Chandrasekaran AN, Kumar A, Shamar PN (1997) Systemic lupus erythematosus in India. Lupus 6:690–700
Ushiyama O, Ushiyama K, Koarada S, Tada Y, Suzuki N, Ohta A et al (2000) Retinal disease in patients with systemic lupus erythematosus. Ann Rheum Dis 59:705–708
Md Noh UK, Zahidin AZA, Yong TK (2012) Retinal vasculitis in systemic lupus erythematosus: an indication of active disease. Clin Pract 2:e54. https://doi.org/10.4081/cp.2012.e54
Klinkhoff AV, Beattie CW, Chalmers A (1986) Retinopathy in systemic lupus erythematosus: relationship to disease activity. Arthritis Rheum 29:1152–1156. https://doi.org/10.1002/art.1780290914
Graham EM et al (1985) Cerebral and retinal vascular changes in systemic lupus erythematosus. Ophthalmology 92(3):444–448
Barile-Fabris L, Hernández-Cabrera MF, Barragan-Garfias JA (2014) Vasculitis in systemic lupus erythematosus. Curr Rheumatol Rep 16:440. https://doi.org/10.1007/s11926-014-0440-9
Kurien BT, Scofield RH (2006) Autoantibody determination in the diagnosis of systemic lupus erythematosus. Scand J Immunol 64:227–235. https://doi.org/10.1111/j.1365-3083.2006.01819.x
Cao X, Bishop RJ, Forooghian F, Cho Y, Fariss RN, Chan C-C (2009) Autoimmune retinopathy in systemic lupus erythematosus: histopathologic features. Open Ophthalmol 3:20–25. https://doi.org/10.2174/1874364100903010020
Hong-Kee N, Mei-Fong C, Azhany Y, Zunaina E (2014). Antiphospholipid syndrome in lupus retinopathy. Clin Ophthalmol Auckl NZ 8:2359–2363. https://doi.org/10.2147/OPTH.S71712
Farrugia E, Torres VE, Gastineau D, Michet CJ, Holley KE (1992) Lupus anticoagulant in systemic lupus erythematosus: a clinical and renal pathological study. Am J Kidney Dis Off J Natl Kidney Found 20:463–471. https://doi.org/10.1016/S0272-6386(12)70258-5
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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.
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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.
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Approved by the Ethical Review board of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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Informed consent was obtained from all individual participants included in the study.
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Seth, G., Chengappa, K.G., Misra, D.P. et al. Lupus retinopathy: a marker of active systemic lupus erythematosus. Rheumatol Int 38, 1495–1501 (2018). https://doi.org/10.1007/s00296-018-4083-4
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DOI: https://doi.org/10.1007/s00296-018-4083-4