It is known that patients with rheumatic diseases can show various ocular manifestations. Ocular involvement is well known in most rheumatic diseases including rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behçet disease, anti-phospholipid syndrome, reactive arthritis and others. Their clinical expression and outcome vary between different populations. Although there are epidemiological studies on uveitis from different geographic areas, registry of patterns of eye affection among rheumatic patients in Egypt is highly deficient. Objective: To identify the prevalence and characteristics of uveitis and other patterns of immune eye involvement in patients referred to Alexandria University outpatient rheumatology clinic during the period from January 2013 to December 2013. Methods: A cross sectional analysis of a cohort of 1500 patients with immune diseases attending the outpatient rheumatology clinic was done. Of these, 100 patients had relevant eye complaints. The demographic features, clinical presentations, patterns of eye involvement, and modes of treatment of eye disease were registered for all patients. Results: 59% of the patients were female. Mean age was 39.26 years and the mean duration of systemic disease was 41 months. Mean duration of eye disease was 30 months. Behcet's disease was the most common identifiable cause of uveitis (24%) followed by JIA associated uveitis (6%) and VKH (5%). Idiopathic anterior uveitis was the most common uveitic entity representing 32% of cases. 14% needed intraocular drug injections. Topical as well as systemic steroids were added in 58%, synthetic or biological DMARDs in 14%, and surgery in 14%. Conclusions: Ocular complications are common among rheumatic patients. Awareness of the possibility of serious eye involvement should always be kept in mind. Routine ophthalmological evaluation of all patients affected with any rheumatic disease is mandatory & should be stressed upon in all guidelines & recommendations in rheumatology.

BackgroundMany are the independent risk factors for premature atherosclerosis in general & peripheral vascular disease (PVD) in particular in SLE patients. Plasma homocysteine (HCY) is a known risk factor for atherosclerosis. Atherosclerosis can lead to many cardiovascular diseases as myocardial infarction, stroke and claudicationObjectivesTo compare the occurrence PVD of the lower extremity of SLE patients (pts) with age and sex matched controls and evaluate the role of HCY level in its occurrenceMethodsBody mass index (BMI), blood pressure, lipid profile, titers of autoantibodies [ANA, anticardiolipin antibodies ACL (IgM, IgG)], C3, C4, plasma HCY level were assessed, SLEDAI and (SLICC/ACRDI)were calculated. PVD evaluation was done by measuring Ankle Brachial Index (ABI) with values <0.9 considered diagnostic of PVD; in 60 SLE pts and 30 age-matched controls. Patients with previous hypertension, diabetes, other collagenic diseases & smokers were excludedResultsEighty-eight percent of the pts were women. The mean age (SD) was 30.40 (11.46) years & mean disease duration 3.61 (4.92)years. 50 pts were asymptomatic, 5 had mild & 5 had moderate claudications.SLE pts had significant higher total cholesterol (TC), LDL than controls 224.1±57.8 vs 181.1±41.1 mg/dl & 162.7±57.0 vs 119.5±13.4 (<0.001*) respectively, higher HCY 11.6±2.1 & 6.4±0.1 μmol/L (p<0.001*) & lower HDL 47.2±13.1 &52.6±3.7 mg/dl (p=0.004*). Low ABI was found in 30% of SLE pts but none of the controls (p=0.001*) & was correlated with higher HCY level (p=0.005*), TC & LDL (p<0.001* & p<0.001*), but not TG (p=0.748) or asymptomatic pts, presence of mild or moderate claudications (p=0.468,1.000, 0.154), still its value negatively correlated with lupus anticoagulant (LA) (p=0.002), ACL IgM (p<0.001*), the presence of lupus nephritis (LN) (p<0.001*) & SLICC/ACRDI (p=0.017*) but not with disease duration (dd) (p=0.535), Anti ds DNA (p=0.364), ACL IgG (p=0.8940), C4 (p=0.168) or SLEDAI (p=0.074).No correlation was found between HCY level and pts' age, dd, age at diagnosis, BMI, Anti ds DNA, ACL IgG, C4 & SLEDAI (p=0.521, 0.098, 0.946, 0.502, 0.346, 0.335, 0.325, 0.787). A positive correlation was found between HCY level and LA, ACL IgM, TC, LDL, the presence of LN & SLICC/ACRDI with a p value of 0.025*, <0.001*, <0.001*, 0.003*, 0.001*, 0.001* & negative one with HDL p=0.023*Conclusions83.3% of SLE pts were asymptomatic or had atypical symptoms of PVD still 30% of the patients had low ABI. ABI can be a more reliable, non-invasive test to assess PVD than the conventional methods of pulse palpation or history of claudication in SLE pts.Both traditional & nontraditional risk factors of atherosclerosis are important but HCY can play a role, among other factors, as independent risk factor of PVD in SLEReferences Rayford R et al. PVD in SLE Patients. J Clin Rheum. 2013; 7:367–70. Disclosure of InterestNone declared