High Rates of Retinopathy Seen in Patients With Systemic Lupus Erythematosus

Approximately a third of systemic lupus erythematosus patients experience ocular involvement, which may be linked to disease pathophysiology.

Patients with systemic lupus erythematosus (SLE) had a higher rate of retinopathy at initial diagnosis, indicating that retinopathy is an early manifestation of the condition, according to a study published in BMC Rheumatology.1 Further, investigators urge ophthalmologic screenings at the time of diagnosis and to analyze any correlation between retinopathy, disease activity, and ocular involvement.

“While data is scarce and based on low-level evidence, approximately a third of SLE patients manifest ocular involvement,” investigators stated. “Ocular manifestations of SLE might be a primary finding related to the disease pathophysiology, due to a secondary disorder, or a complication of treatment.”

In this cross-sectional study, investigators assessed patients with SLE at a tertiary referral clinic in Tehran, Iran, between March 2016 and March 2017. Eligible patients were aged 18 years or older and were diagnosed with SLE according to American College of Rheumatology (ACR) criteria. Patients were either newly diagnosed at the clinic or diagnosed at another hospital but had not received any treatment at the time of enrollment.

Demographics and clinical data were reported, including vasculitis, constitutional symptoms, headache, and musculoskeletal involvement. Laboratory tests involved a complete blood count, C-reactive protein (CRP), liver enzymes, erythrocyte sedimentation rate (ESR), serum creatinine, urinalysis, and anticardiolipin antibody (aCL). Disease activity was determined using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).

An ophthalmologist, who had no prior knowledge of disease severity or clinical manifestation, performed a slit-lamp examination. Retinal pathologies included optic atrophy, papilledema, retinal vascular attenuation, cotton wool spots, and intraretinal hemorrhages. Patients were categorized as either those with retinopathy or those without retinopathy.

Out of a total of 114 patients, 18 (15.8%) were diagnosed with retinopathy, although none had any ophthalmic symptoms. The mean age was 31.4 ± 9.5 years and 99 (87%) were female. The most common retinal findings were cotton-wool spots (n = 14, 78%), retinal hemorrhage (n = 3, 17%), and Roth spot (n = 1, 5%).

Patients with retinopathy had a significantly higher SLEDAI score when compared with those without (22 ± 7.9 vs 11 ± 6, P < 0.001). They were also more likely to have casts in their urinalysis (P = 0.006) and had significantly lower hemoglobin levels (P = 0.012) and serum C3 and C4 levels (55 ± 15 vs 85 ± 15, P = 0.001; 12 ± 10 vs 90 ± 18, P = 0.036, respectively). Additionally, anti-nuclear antibody (ANA) and anti-double-strand DNA (anti-dsDNA) autoantibody levels were significantly higher in the retinopathy cohort (5.7 ± 1.1 vs 4.5 ± 0.8, P = 0.012; 109 ± 22 vs 71 ± 17, P = 0.049, respectively).

Limitations include the study design, not including patients undergoing treatment for SLE, and that prevalence of retinopathy may be different than other patients, as participants were referred from an SLE clinic. However, excluding patients with hypertension and diabetes and utilizing a priori power analysis strengthen the study.

“Our findings suggest that retinopathy might be an early manifestation of the disease, and ophthalmologic screening might be considered for SLE patients at the time of diagnosis, especially for those with severe disease,” investigators concluded. “We also encourage researchers to further evaluate the correlation between retinopathy and disease activity, and the prognosis of ocular involvement with current treatment algorithms.”

Reference:

Bashiri H, Karimi N, Mostafaei S, Baghdadi A, Nejadhosseinian M, Faezi ST. Retinopathy in newly-diagnosed systemic lupus erythematosus: should we screen for ocular involvement?. BMC Rheumatol. 2021;5(1):34. Published 2021 Oct 1. doi:10.1186/s41927-021-00203-5