Ocular Manifestations of Systemic Lupus Erythematosus and Systemic Lupus Erythematosus with Antiphospholipid Syndrome.

Vijaybabu Sathishkumar, J R S (2010) Ocular Manifestations of Systemic Lupus Erythematosus and Systemic Lupus Erythematosus with Antiphospholipid Syndrome. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Systemic Lupus Erythematosus (SLE) is a chronic, relapsing and remitting, autoimmune disorder. The clinical presentations are diverse and depend on the organ systems involved. Potentially life-threatening complications may occur. A pathologic immune response involving the production of autoantibodies and immune complex mediated tissue damage is thought to play a central role in the disease process . Genetic, environmental, and possibly hormonal influences may also be contributing factors. Women with SLE outnumber men by 9 : 1 and the peak age of onset ranges from the late teens to the fourth decade of life. Individuals of African or Asian descent appear to be at greatest risk for developing the condition. Systemic treatment options generally include antimalarial drugs, corticosteroids, and other immunosuppressive agents. A variety of newer targeted treatment modalities are under development. AIMS AND OBJECTIVES : The aim of the work was to assess ; 1. the frequency of eye changes among patients with SLE, 2. the association between anti-phospholipid antibodies and ocular lesions, 3. the correlation of the ocular manifestations with disease activity, 4. the relationship between the presence of circulating autoantibodies and eye changes. MATERIALS AND METHODS : Study Design: Prospective study. Study Centre: Department of Rheumatology, Madras Medical College& Government General Hospital, Chennai -3. Study Period: March - 2009 to March – 2010. Study Population: Consecutive cases of lupus patients who are attending the Department of Rheumatology, GGH Chennai. Study Sample: 110 patients. Inclusion Criteria: 1. Patients who satisfied the 1997 Revised Criteria for the Classification of Systemic Lupus Erythematosus (SLE), 2. AGE: All age group, 3. SEX: Both genders. Exclusion Criteria: 1. Patients who do not satisfy the 1997 Revised Criteria for the Classification of Systemic Lupus Erythematosus (SLE), 2. Patients with overlap syndrome. RESULTS : The present study consisted of 110 SLE patients. There were 11 males and 99 females in the study group [Fig. 1]. The age of the patients varied from 9 years to 65 years [Fig. 2]. The mean age of the patients was 25.9±9.2 years. The mean duration of disease was 29±30.8 months with disease onset in the second or third decade being the commonest. 12[10.9%] patients had childhood onset of the disease [Fig. 3] with mean age being 13±2.13 years. The mean disease duration in childhood onset was 12.25±7.84 months. Chi squared equals 1.893 with 1 degree of freedom. The two-tailed P value equals 0.1689. This implies that the ophthalmic involvement is independent of disease duration in SLE patients. CONCLUSION : 1. There was a female predominance in the patients with ocular involvement due to Systemic Lupus Erythematosus. 2. Ocular manifestations were seen in 36.4% of our study patients. 3. Ocular complaints were given by 20.9% of patients. 4. Keratoconjunctivitis sicca or dry eyes was the most common finding affecting 11.8% of patients. Retinal vasculitis was seen in 4.5% of our patients. Posterior sub capsular cataract due to steroid use was seen in 3.6% of our patients. Chloroquine maculopathy was seen in 1.8% of our patients. 5. Neuro-ophthalmic manifestations were less common involving 1.8% of our patients. 6. Ocular infections involving 5.5% of our patients, were less common and are not life or vision threatening. 7. There exists no relationship between ophthalmic status of SLE patients, age of the patient and disease duration . 8. The frequency of anticardiolipin antibodies was 23.6% and LAC study was 11.8% in our patients. Their presence is positively correlated with ocular involvement. 9. Ocular involvement is positively associated with recurrent abortions, thrombocytopenia, Anti-dsDNA positivity, aCL positivity, low complement levels and high SLEDAI score. 10. Sight-threatening complications of SLE include optic neuropathy and retinal vascular disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ocular Manifestations ; Systemic Lupus Erythematosus ; Systemic Lupus Erythematosus ; Antiphospholipid Syndrome.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:46
Last Modified: 16 Aug 2017 06:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/1817

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