Study Points to Connection Between Childhood-onset Lupus and Uveitis

Report underscores the need to act quickly, refer patients with eye problems.

A new study bolsters the case that the link between systemic lupus erythematosus and uveitis is both rare and real.

The research focused specifically on childhood-onset systemic lupus erythematosus (cSLE) and was based on an analysis of the medical records of 852 cSLE patients in Brazil. Scientists from the University of Sao Paulo were seeking to assess the prevalence of uveitis among pediatric lupus patients.

Overall, only seven cases of uveitis were reported among the patient cohort (0.8%). However, six of those seven uveitis cases were diagnosed within six months of the initial cSLE diagnosis, prompting researchers to hypothesize that the two conditions might be linked.

Of the seven uveitis cases, one led to total blindness and another led to blindness in one eye.

In a subsequent analysis comparing the seven cSLE patients with uveitis to 73 cSLE patients who did not develop uveitis, researchers noted that the patients who went on to develop uveitis had much higher scores on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K). The SLEDAI-2K index measures disease flare-ups. cSLE patients without uveitis had average scores of six, which lands on the low end of the “moderate” category on the SLEDAI-2K scale. However, cSLE patients who developed uveitis had average SLEDAI-2K scores of 19, near the upper end of “severe” on the scale.

The analysis also showed that cSLE patients with uveitis manifestations had higher rates of fever, lymphadenopathy, arthritis, and use of methylprednisolone pulses. An adjusted regression analysis further showed that fever was the biggest warning sign for uveitis, regardless of SLEDAI-2K scores.

This is not the first study to link lupus and uveitis—far from it. A 2015 study by English researchers looked at more than three decades of patient records. In that study, which encompassed 53,315 patients, SLE was determined to have caused uveitis in about 0.47% of the SLE population. The researchers wanted to know if it made sense to perform routine antinuclear antibody testing in uveitis patients in order to diagnose SLE. The answer, they found, was “not in most cases.”

“These data suggest such testing should be reserved for patients where there is a higher pretest probability of SLE,” wrote the authors, who were affiliated with Moorfields Eye Hospital National Health Society Foundation Trust.

Another British study, published in 2007 by scientists from the University of Birmingham, said while more research is needed into the exact links between lupus and eye problems, rheumatologists need to take a proactive approach and be quick to refer patients with eye issues to an ophthalmologist.

“Early recognition by the rheumatologist, prompt assessment by the ophthalmologist and coordinated treatment strategies are key to reducing the ocular morbidity associated with this disease,” the authors concluded.

The Lupus Foundation of America lists a number of other eye-related complications that can arise from the disease. They include dry eyes, scleritis, retinal vascular lesions, and neuro-ophthalmic involvement. However, these complications are less common than flare-ups in other parts of the body, such as the heart, joints, and skin.

The new childhood SLE study, entitled “Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey,” was published January 9 in Clinical Rheumatology.

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