Role of lupus retinopathy in systemic lupus erythematosus

Ranju Kharel (Sitaula)1, Dev Narayan Shah1, Divya Singh2
1Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
2Department of Internal Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Nepal

Tóm tắt

Lupus retinopathy is one of the most common vision-threatening complications of systemic lupus erythematosus. The presence of lupus retinopathy is an accurate guide to the presence of active systemic disease activity. A prospective study was conducted looking at 91 established cases of systemic lupus erythematosus to evaluate lupus retinopathy. The patients were divided into two groups according to the presence or absence of lupus retinopathy, and a comparison of clinical and laboratory findings between two groups was done. Among 91 SLE patients, 5 were male and 86 were female; of which, 85 (93.4 %) were outpatients and 6 (6.6 %) were inpatients. Lupus retinopathy was found in 13 eyes of 11 cases out of 91 cases (12.1 %). Among these 13 eyes with lupus retinopathy, 61.5 % had mild type of lupus retinopathy, 15.4 % had moderate type, and 23.1 % had severe lupus retinopathy. The mean age of the cases at ophthalmological examination with and without retinopathy was 30.4 and 31.9 years, respectively. The mean serum creatinine level was 190.4 μmol/l which was higher than in the patients without retinopathy (96.2 μmol/l). The mean ESR in patients with retinopathy was higher than without retinopathy (34.2 vs. 32). Similarly, the mean platelet count in SLE patients with retinopathy was 154,245/μl and in SLE patients without retinopathy was 135,828/μl. Retinal lesions in SLE patients are of critical importance, both visually and prognostically.

Tài liệu tham khảo

Reddy CV, Foster C (1994) Systemic lupus erythematosus. In: Jakobiec FA, Albert DM (eds) Principles and Practice of Ophthalmology. WB Saunders, Philadelphia Read RW (2004) Clinical mini-review: systemic lupus erythematosus and the eye. Ocul Immunol Inflamm 12(2):87–99 Sobrin L, CS Foster (1994) Systemic lupus erythematosus choroidopathy BMJ, IV Reddy CV, FCSleIAD, Jakobiec FA (1994). Principles and practice of ophthalmology. WB Saunders: Philadelphia, 2894 ± 2901 Stafford‐Brady FJ et al (1988) Lupus retinopathy. Arthritis Rheum 31(9):1105–1110 Giorgi D et al (1999) Retinopathy in systemic lupus erythematosus: pathogenesis and approach to therapy. Hum Immunol 60(8):688–696 Coppeto J, Lessell S (1977) Retinopathy in systemic lupus erythematosus. Arch Ophthalmol 95(5):794–797 Jabs DA et al (1986) Severe retinal vaso-occlusive disease in systemic lupus erythematosus. Arch Ophthalmol 104(4):558–563 Au A, O’Day J (2004) Review of severe vaso‐occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: associations, visual outcomes, complications and treatment. Clin Experiment Ophthalmol 32(1):87–100 Hall S, Buettner H, Luthra HS (1984) Occlusive retinal vascular disease in systemic lupus erythematosus. J Rheumatol 11(6):846–850 Tan EM et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25(11):1271–1277 Wasef SZY (2004) Gender differences in systemic lupus erythematosus. Gend Med 1(1):12–17 Ushiyama O (2000) Retinal disease in patients with systemic lupus erythematosus. Ann Rheum Dis 59(9):705–708 Gold D, Morris D, Henkind P (1972) Ocular findings in systemic lupus erythematosus. Br J Ophthalmol 56(11):800 Yap E et al (1998) Ophthalmic manifestations in Asian patients with systemic lupus erythematosus. Singapore Med J 39(12):557–559 Kanda N, Tsuchida T, Tamaki K (1996) Testosterone inhibits immunoglobulin production by human peripheral blood mononuclear cells. Clin Exp Immunol 106(2):410–415 Kotzin BL, West SG (2001) Systemic lupus erythematosus. In: Rich RR, Shearer WT, Kotzin BL, Schroeder (eds) Clinical immunology: principles and practice, F.T, vol 60. Mosby, London, pp 1–60 Levine SR, Welch K (1987) The spectrum of neurologic disease associated with antiphospholipid antibodies: lupus anticoagulants and anticardiolipin antibodies. Arch Neurol 44(8):876 Graham EM et al (1985) Cerebral and retinal vascular changes in systemic lupus erythematosus. Ophthalmology 92(3):444–448 Klinkhoff AV, Beattie CW, Chalmers A (1986) Retinopathy in systemic lupus erythematosus: relationship to disease activity. Arthritis Rheum 29(9):1152–1156 Hahn BH (2005) Systemic Lupus Erythematosus. In: Kasper AFD, Longo D, Braunwld E, Hauser S, Jameson JF (eds) in Harrison’s Principles of Internal Medicine. McGraw-Hill Companies, p 1962 Donders R et al (1998) Transient monocular blindness and antiphospholipid antibodies in systemic lupus erythematosus. Neurology 51(2):535–540 Montehermoso A, Cervera R, Font J, Ramos-Casals M, García-Carrasco M, Formiga F, Ingelmo M (1999). Association of antiphospholipid antibodies with retinalvascular disease in systemic lupus erythematosus. In Seminars in arthritis and rheumatism. vol. 28, No. 5, WB Saunders, pp 326-332