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Rheumatology International

, Volume 38, Issue 8, pp 1495–1501 | Cite as

Lupus retinopathy: a marker of active systemic lupus erythematosus

  • Gaurav Seth
  • K. G. Chengappa
  • Durga Prasanna Misra
  • Ramesh Babu
  • Pooja Belani
  • K. C. Shanoj
  • Gunjan Kumar
  • Vir Singh Negi
Observational Research
  • 120 Downloads

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.

Keywords

Systemic lupus erythematosus Disease activity Retinopathy Neuropsychiatric lupus Lupus nephritis Seizures 

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

Notes

Author contributions

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.

Funding

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.

Ethical approval

Approved by the Ethical Review board of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical ImmunologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
  2. 2.Department of OphthalmologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
  3. 3.Department of Clinical ImmunologySanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)LucknowIndia
  4. 4.Department of Preventive and Social MedicineJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia

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