Association of Systemic Lupus Erythematosus With Uveitis

Abstract

ystemic lupus erythematosus is a systemic autoimmune condition that can be associated with uveitis. The prevalence of SLE as a cause of uveitis varies in the literature. In 1990, Rosenbaum and Wernick 1 reported on the use of routine antinuclear antibody (ANA) testing for patients with uveitis. Their Bayesian analysis required a pretest probability of SLE in patients with uveitis. Rosenbaum and Wernick 1 estimated a prevalence of SLE as a cause of uveitis as 0.1%. This estimate was based on 1218 patients in 3 studies in the 1980s where SLE was neither found nor explicitly mentioned. Based on this prevalence, they estimated that with a positive ANA test result in a patient with uveitis, the chance of the patient having SLE was less than 1%. They recommended against the routine screening of patients with uveitis with ANA testing in the absence of other features suggestive of SLE. A higher pretest probability resulted in a higher posttest probability.Rodriguez et al 2 described the etiology of uveitis in 1237 patients attending the Massachusetts Eye and Ear Infirmary, reporting the prevalence of SLE as 4.8%. Substituting this value for pretest probability into the Bayesian analysis performed by Rosenbaum and Wernick 1 resulted in a 24% posttest probability of having SLE. Thus, the prevalence of SLE in uveitis determines the value of routine ANA testing.

Evidence for the Detection of Subclinical Retinal Involvement in Systemic Lupus Erythematosus and Sjögren Syndrome: A Potential Association with Therapies

“…The major pathological changes in lupus retinopathy are attributed to vasculopathy rather than a true vasculitis, characterized most commonly by an immune complex-mediated microangiopathy [7]. Retinopathy in SLE is suggestive of elevated disease activity and correlates with central nervous system and kidney involvement during the course of SLE, and is a marker of poor prognosis for survival [6-9]. It may also indicate inadequate control of systemic disease [9, 10].…”

“…Retinopathy in SLE is suggestive of elevated disease activity and correlates with central nervous system and kidney involvement during the course of SLE, and is a marker of poor prognosis for survival [6-9]. It may also indicate inadequate control of systemic disease [9, 10]. Treatment strategies for SLE include hydroxychloroquine (HCQ) or chloroquine (CQ) and systemic glucocorticoids (GCs), both correlated with a possible risk of visual impairment [11-13].…”

Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey

“…On the other hand, a retrospective analysis of uveitis etiology in 269 patients younger than 16 years old referred to an ophthalmological tertiary center found only one case of lupus [20], and a recent review of studies on the prevalence of SLE in patients with uveitis [21] reported rates varying from 0.1 to 4.8%. A prospective study of patients presenting with uveitis at an ophthalmology reference center in São Paulo, Brazil, including 15.3% of patients younger than 18 years old, showed that SLE was identified as the cause of uveitis in 14 out of 1053 (1.33%) patients.…”

Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee

“…A review of the literature has shown that the prevalence of lupus is 0.47% in patients with uveitis and the PPV of antinuclear antibodies for the diagnosis is <3% [106]. Other studies have confirmed that immunologic investigations are rarely useful for the etiologic diagnosis of uveitis [83,84].…”