More than 15% of newly-diagnosed patients with lupus exhibit evidence of retinopathy
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Patients with systemic lupus erythematosus demonstrate a relatively high rate of retinopathy at initial diagnosis, and may represent an early manifestation of the disease, according to data published in BMC Rheumatology.
“While cutaneous, renal, and musculoskeletal involvement is more common, ocular manifestations of SLE have also been reported in at least a third of patients,” Hamidreza Bashiri, MD, of Shahid Sadoughi Hospital, in Yazd, Iran, and colleagues wrote. “Although ocular manifestations are not recognized as a diagnostic criterion by the American College of Rheumatology (ACR), their effects on the patient’s quality of life should not be overlooked, as potentially devastating complications are not rare, and treatment becomes substantially less effective at later stages of involvement.”
“There is no clear evidence on how prevalent ocular disease is at the time of diagnosis or whether such involvement happens later during the disease course,” they added. “If the latter is true, screening for ocular involvement might not be beneficial when SLE is diagnosed. However, if ocular lesions are prevalent in newly diagnosed patients at a nascent pathologic stage, screening for such lesions would be warranted to ensure early diagnosis, prompt treatment, and proper follow-up.”
To examine the prevalence of retinopathy in patients newly diagnosed with SLE, Bashiri and colleagues conducted a cross-sectional study of participants recruited from a tertiary referral clinic in Tehran, Iran, between March 2016 and March 2017. Participants were adults with newly diagnosed SLE who had not yet received treatment. Those with hypertension, diabetes mellitus or coagulopathy were excluded. In all, the final analysis included 114 participants.
The researchers recorded clinical findings and laboratory test results for all patients, who were additionally examined by an ophthalmologist for evidence of retinal pathologies. Bashiri and colleagues also calculated SLE disease activity index scores for all participants.
According to the researchers, the prevalence of retinopathy was 15.8%. Cotton-wool spots were the most common finding, represented in 78% of patients with retinopathy. The researchers also found that patients with retinopathy demonstrated significantly lower hemoglobin levels, C3 and C4 concentrations, as well as higher antinuclear antibody and anti-dsDNA levels. Patients with retinopathy additionally had a significantly higher SLE disease activity index score.
“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,” Bashiri and colleagues wrote. “We also encourage researchers to further evaluate the correlation between retinopathy and disease activity, and the prognosis of ocular involvement with current treatment algorithms.”
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