Skip to main content

Advertisement

SpringerLink
Log in

Analysis of the prevalence of cataracts and glaucoma in systemic lupus erythematosus and evaluation of the rheumatologists' practice for the monitoring of glucocorticoid eye toxicity

  • Brief Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Chronic glucocorticoid (GC) therapy is associated with an increased risk of developing cataracts and glaucoma, and recommendations have been developed for monitoring these side effects in patients with rheumatic diseases. The aim of this study was to assess the prevalence of cataracts and glaucoma and the adherence to the existing recommendations for monitoring eye toxicity of chronic GC therapy among systemic lupus erythematosus (SLE) patients in routine clinical practice. Clinical charts of 170 patients were examined, and 34 (20 %) of them never underwent an eye assessment. The remaining 136 underwent an eye assessment with an interval of 75 ± 61.7 months. Only 45 (33 %) had received an evaluation during the previous 12 months. All these 170 patients were taking chronic CG therapy at a mean daily dose of 5.4 ± 2.4 mg prednisone and a mean cumulative dose of 27.6 ± 20.5 g. Out of the 136 patients with at least one eye assessment, cataracts were observed in 39 patients (29 %) and glaucoma in 4 patients (3 %). Cataracts were diagnosed at a mean age of 46.5 ± 10 years; the development of cataracts was associated with age, disease duration, and cumulative GC dose. Glaucoma was diagnosed at a mean age of 40.5 ± 16 years; due to the small number of patients, no correlations were made. The prevalence of cataracts and glaucoma is higher than in the general population, and these conditions occur early in the life of SLE patients. An association between GC and cataracts is confirmed. The adherence to recommendations is suboptimal as only 33 % of patients underwent an eye assessment over the previous 12 months. These data reinforce the need to improve adherence to recommendations for eye monitoring among SLE patients under chronic therapy with GC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mosca M, Tani C, Carli L, Bombardieri S (2011) Glucocorticoids in systemic lupus erythematosus. Clin Exp Rheumatol 29(5 Suppl 68):S126–129

    PubMed  CAS  Google Scholar 

  2. Mosca M, Tani C, Neri C, Baldini C, Bombardieri S (2006) Undifferentiated connective tissue diseases (UCTD). Autoimmun Rev 6:1–4

    Article  PubMed  CAS  Google Scholar 

  3. Mosca M, Tani C, Talarico R, Bombardieri S (2011) Undifferentiated connective tissue diseases (UCTD): simplified systemic autoimmune diseases. Autoimmun Rev 10:256–258

    Article  PubMed  Google Scholar 

  4. Agmon-Levin N et al (2012) Systemic lupus erythematosus one disease or many? Autoimmun Rev 11:593–595

    Article  PubMed  CAS  Google Scholar 

  5. Govoni M, Bombardieri S, Bortoluzzi A, Caniatti L, Casu C, Conti F et al (2012) Factors and comorbidities associated with first neuropsychiatric event in systemic lupus erythematosus: does a risk profile exist? A large multicentre retrospective cross-sectional study on 959 Italian patients. Rheumatology 51:157–168

    Article  PubMed  Google Scholar 

  6. Van der Goes MC, Jacobs JW, Boers M, Andrews T, Blom-Bakkers MA, Buttgereit F et al (2010) Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Ann Rheum Dis 69:1913–1919

    Article  PubMed  Google Scholar 

  7. Hoes JN, Jacobs JW, Boers M, Boumpas D, Buttgereit F, Caeyers N et al (2007) EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 66(12):1560–1567

    Article  PubMed  CAS  Google Scholar 

  8. Peponis V, Kyttaris VC, Chalkiadakis SE, Bonovas S, Sitaras NM (2010) Ocular side effects of anti-rheumatic medications: what a rheumatologist should know. Lupus 19:675–682

    Article  PubMed  CAS  Google Scholar 

  9. Da Silva JAP, Jacobs JWG, Kirwan JR, Boers M, Saag KG, Inês LBS et al (2006) Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis 65:285–293

    Article  PubMed  Google Scholar 

  10. Shun-Shin GA, Brown NP, Bron AJ, Sparrow JM (1989) Dynamic nature of posterior subcapsular cataracts. Br J Ophthalmol 73:522–527

    Article  Google Scholar 

  11. James ER (2007) The etiology of steroid cataract. J Ocul Pharmacol Ther 23:403–20

    Article  PubMed  CAS  Google Scholar 

  12. Carnahan MC, Goldstein DA (2000) Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 11:478–483

    Article  PubMed  CAS  Google Scholar 

  13. Tripathi RC, Parapuram SK, Tripathi BJ, Zhong Y, Chalam KV (1999) Corticosteroids and glaucoma risk. Drugs Aging 15:439–450

    Article  PubMed  CAS  Google Scholar 

  14. Boonyaleephan S (2010) Drug-induced secondary glaucoma. J Med Assoc Thai 93(Suppl 2):S118–22

    PubMed  Google Scholar 

  15. Fel A, Aslangul E, Le Jeunne C (2012) Eye and corticosteroid's use. Presse Med 41:414–21

    Article  PubMed  Google Scholar 

  16. Prokofyeva E, Wegener A, Zrenner E (2013) Cataract prevalence and prevention in Europe: a literature review. Acta Ophthalmol. doi:10.1111/j.1755-3768.2012.02444.x

  17. Wolfs RCW, Borger PH, Ramrattan RS, Klaver CCW, Hulsman CAA, Hofman A et al (2000) Changing views on open-angle glaucoma: definitions and prevalences—the Rotterdam study. Invest Ophthalmol Vis Sci 41:3309–3321

    PubMed  CAS  Google Scholar 

  18. Quigley HA, Vitale S (1997) Models of open-angle glaucoma prevalence and incidence in the United States. Invest Ophthalmol Vis Sci 38(1):83–91

    PubMed  CAS  Google Scholar 

  19. Prokofyeva E, Zrenner E (2012) Epidemiology of major eye diseases leading blindness in Europe: a literature review. Ophthalmic Res 47:171–188

    Article  PubMed  Google Scholar 

  20. Huscher D, Thiele K, Gromnica-Ihle E, Hein G, Demary W, Dreher R, Zink A, Buttgereit F (2009) Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 68:1119–24

    Article  PubMed  CAS  Google Scholar 

  21. Mosca M, Bombardieri S (2007) Disease-specific quality indicators, guidelines, and outcome measures in systemic lupus erythematosus (SLE). Clin Exp Rheumatol 25(Suppl 47):107–113

    PubMed  CAS  Google Scholar 

  22. Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Brey R et al (2010) European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 69:1269–1274

    Article  PubMed  CAS  Google Scholar 

  23. Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Cervera R et al (2011) Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice. Autoimmun Rev 10:383–388

    Article  PubMed  CAS  Google Scholar 

  24. Yazdany J, Panopalis P, Gillis JZ, Schmajuk G, MacLean C, Wofsy D et al (2009) A quality indicator set for systemic lupus erythematosus. Arthritis Rheum 61:370–377, 15

    Article  PubMed  Google Scholar 

  25. Tani C, Carli L, Mosca M, Baldini C, Consensi A, Doveri M et al (2011) Adherence to cervical cancer screening in an Italian SLE cohort. Reumatismo 63:11–17

    PubMed  CAS  Google Scholar 

Download references

Disclosures

None.

Author information

Authors and Affiliations

  1. Rheumatology Unit, University of Pisa, Via Roma, 67, 56126, Pisa, Italy

    L. Carli, C. Tani, F. Querci, A. Della Rossa, S. Vagnani, C. Baldini, R. Talarico, A. d’Ascanio, R. Neri, S. Bombardieri & M. Mosca

  2. Clinical Immunology Unit, University of Pisa, Pisa, Italy

    A. G. Tavoni

Authors
  1. L. Carli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Tani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Querci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Della Rossa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Vagnani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Baldini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Talarico
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. d’Ascanio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Neri
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. G. Tavoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Bombardieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Mosca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Mosca.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carli, L., Tani, C., Querci, F. et al. Analysis of the prevalence of cataracts and glaucoma in systemic lupus erythematosus and evaluation of the rheumatologists' practice for the monitoring of glucocorticoid eye toxicity. Clin Rheumatol 32, 1071–1073 (2013). https://doi.org/10.1007/s10067-013-2214-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-013-2214-6

Keywords

Search

Navigation