Systemic lupus erythematosus: An update for ophthalmologists

Abstract

Systemic lupus erythematosus (SLE) is a life-threatening multisystem inflammatory condition that may affect almost any part of the eye. We provide an update for the practicing ophthalmologist comprising a systematic review of the recent literature presented in the context of current knowledge of the pathogenesis, diagnosis, and treatment of this condition. We review recent advances in the understanding of the influence of genetic and environmental factors on the development of SLE. Recent changes in the diagnostic criteria for SLE are considered. We assess the potential for novel molecular biomarkers to find a clinical application in disease diagnosis and stratification and in the development of therapeutic agents. We discuss limited forms of SLE and their differentiation from other collagen vascular disorders and review recent evidence underlying the use of established and novel therapeutics in this condition, including specific implications regarding monitoring for ocular toxicity associated with antimalarials.

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

“…It is well known that the prevalence of retinopathy has reduced dramatically since the introduction of corticosteroids in SLE treatment, from about half to just 10% of patients [2, 53]. The pathogenesis of retinopathy is mostly attributed to a vasculopathy, in particular microangiopathy [2, 54]. In our cohort, we did not detect evident signs of microangiopathy, although these alterations might be better demonstrated using angiographic techniques not actually performed in the absence of a clear clinical indication and as they are technically invasive.…”

Severity of dry eye syndrome is related to anti-dsDNA autoantibody in systemic lupus erythematosus patients without secondary Sjogren syndrome

“…Moreover, Vasilev et al [ 36 ] illustrated that C3 played a crucial role in disrupting the alternative complement pathway in patients with lupus nephritis. On the contrary, in a recent review by Papagiannuli et al, [ 21 ] C4 was pointed out to be particularly important for the clearance of immune complexes in SLE via the classical complement pathway. In other words, low C3 and C4 are both important indicators for lupus activity due to their involvements in classical and alternative complement pathways, but C4 is less capable of monitoring lupus activity.…”

When systemic lupus erythematosus affects vision: a rare presentation of this condition

“…SLE is a chronic autoimmune illness with affection of all organs and systems, including without exception the eye and all elements of the visual system 1. Ocular involvement can be observed in one-third of SLE patients and 10% of these have retinopathy 4 6 8. Although ocular presentation as an initial manifestation of SLE is rare, prevalence studies report an association with systemic disease activity.…”

“…All these findings define a spectrum of ocular SLE involvement allowing for the definition of three main scenarios: lupus retinopathy, retinal vascular occlusion and retinal vasculitis 8. Antiphospholipid syndrome must be screened in all patients because it is associated with more severe retinopathy and a higher frequency of vascular occlusion 4 6 10…”

“…Current classifying systems adopted by the American College of Rheumatology,2 and the Systemic Lupus Erythematosus International Collaborating Clinics,3 comprise immunological and clinical criteria but do not include eye involvement as a condition defining SLE. Ocular affection of SLE can involve several ocular structures including eyelids, conjunctiva, episclera, sclera, cornea, retina, uveal tract, optic nerve, vasculature and the orbit,4–6 and may herald systemic symptoms or central nervous system lupus 7. The authors describe a prospectively documented case of lupus retinopathy as the initial feature of SLE.…”