Background Systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases affecting multiple systems and organs. Retinal vasculopathy (RV) in SLE patients has a reported incidence of 3–29%1–2and often leads to poor visual outcome. However, there are limited data to date on this condition in Chinese patients, which might underestimate the importance of SLE with RV in daily practice.
Objectives To analyze medical records of SLE inpatients from January 2006 to January 2016 and compare the clinical characteristics of SLE patients with and without RV.
Methods All patients admitted to Peking Union Medical College Hospital from January 2006 to January 2016 fulfilled the revised ACR classification criteria for SLE (1997)3. For each case, two controls were randomly selected from contemporaneous SLE patients without clinical ophthalmic complaints.
Results (1) The prevalence of RV was 0.66% (35/5298) in our cluster of SLE patients. The median duration of SLE before clinical retinal vascular disease was 12 months (range 0–168months). Seven out of 35 (20%) SLE patients with RV complained of ophthalmic disorders before they were diagnosed with SLE. Two patients presented ophthalmological disorder as initial manifestation. A total of 60 eyes were involved in these patients. Most (48/60, 80%) eyes presented with a decrease of visual acuity, 7/60 eyes had visual field loss, and 3/60 eyes presented diplopia.
The ophthalmic examination revealed cotton-wool spots (30/60, 50%), retinal vascular stenosis (31/60, 51.6%), vaso-occlusion (16/60, 26.7%) and hemorrhage (41/60, 68.3%)(Fig. 1).
(2) The nervous system involvement (51.4 vs. 24.3%, P=0.005) and hematological disturbance (62.9% vs. 34.3%, P=0.005) presented more frequently in patients in the case group than the control group.Patients in the case group presented a much lower frequency of positive anti-SSA antibodies than the control group (34.3% vs. 67.1%, P=0.001).
The patients in the case group had a more active SLE disease index. The mean (± SE) SLEDAI score was 19.9±0.9 points in cases compared to 10.2±0.7 points in controls (P<0.001).
(3)Nervous system disturbance (OR =4.340, 95% CI 1.438, 13.094, P=0.009) and leukocytopenia (OR =6.385, 95% CI 1.916, 21.278, P=0.003) were the independent risk factors, while anti-SSA antibody positive (OR =0.249, 95% CI 0.087, 0.710, P=0.009) was a protective factor for RV in SLE patients.
Conclusions RV is one of serious ocular lesions in SLE patients not received enough attention yet in our Chinese clinical work. Fundus examination is recommended to be performed as soon as a patient is diagnosed with SLE to screen potential cases of RV in SLE patients. On the other hand, all RV patients with uncertain causes should be referred to a rheumatologist for further screening of SLE.
Silpa-Archa S, Lee JJ, Foster CS, et al. Ocular involvement in systemic lupus erythematosus. Br J Ophthalmol. 2016; 100(1):135–41.
Androudi S, Dastiridou A, Symeonidis C, et al. Retinal vasculitis in rheumatic diseases: an unseen burden. Clin Rheumatol. 2013;32(1):7–13.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725.
Disclosure of Interest None declared