Prednisone Dose, Hypertension Linked to Cataracts in SLE


Followup of the Hopkins Lupus Cohort shows cataracts relatively rare within a mean 4 years of followup, and suggests some ways to reduce the risk.

Alderaan K, Sekicki V, Magder LS, Petri M. Risk factors for cataracts in systemic lupus erythematosus (SLE). Rheumatology International (2014) Epub ahead of print Sept. 26. doi: 10.1007/s00296-014-3129-5

Patients with systemic lupus erythematosus (SLE), this study shows, are at high risk for cataracts if they have taken high doses of steroids for 10 years, have high disease activity or elevated blood pressure.

These researchers have previously identified a link between steroid dose and cataract formation. Here, the main object of the study was to identify modifiable risk factors (assuming that steroid use may be unavoidable).

During a mean 4.1 years of followup among 2,109 patients in the Hopkins Lupus Cohort, the research team observed 157 incident cataracts arising prior to age 60 (therefore likely not age-related). This is a rate of 7.4%, at the low end of the range of previously reported prevalences for cataracts in SLE (5% to 32%). 

The Hopkins data show that, after adjustments for other factors, a cumulative prednisone dose equivalent to 10 mg/day for 10 years (RR = 2.9, P = 0.0010) is a strong predictor for cataracts. Other significant risk factors were disease activity measured by SELENA-SLEDAI (P = 0.0004) and higher systolic blood pressure (P = 0.0003).

Duration of SLE was not associated with cataract development in this study, in which 40% of subjects had been diagnosed within the previous year but a third five years or more earlier. Nor were comorbid diabetes mellitus or kidney disease, smoking or serum cholesterol,  immunological profile, or medication use other than prednisone significant predictors.

The report delves into the cellular mechanisms whereby corticosteroids and inflammatory factors may contribute to cataract formation. The role of hypertension isn't clear as yet. But since there’s no preventive therapy for corticosteroid-induced cataracts in SLE, the authors underscore the importance of controlling disease activity and hypertension in the interests of avoiding them.

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