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Neurodegeneration in systemic lupus erythematosus: layer by layer retinal study using optical coherence tomography
Arnaldo Dias-Santos1,2,3,4, Joana Tavares Ferreira1,2,3, Sofia Pinheiro5
11Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
International Journal of Retina and Vitreous
|April 28, 2020
Summary
Systemic lupus erythematosus (SLE) patients show early retinal neurodegeneration, with thinner nerve fiber and photoreceptor layers. These changes are linked to disease activity and cardiovascular risks.
Area of Science:
- Ophthalmology
- Rheumatology
- Neuroscience
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with frequent, often asymptomatic, central nervous system involvement.
- Recent imaging and cognitive studies highlight the high prevalence of neurological issues in SLE patients.
- Early detection of neurodegeneration is crucial for managing SLE complications.
Purpose of the Study:
- To identify early signs of retinal neurodegeneration in SLE patients without ophthalmologic symptoms.
- To compare peripapillary retinal nerve fiber layer (pRNFL) and macular layer thickness between SLE patients and healthy controls.
- To investigate the influence of disease duration and comorbidities on retinal changes in SLE.
Main Methods:
- A cross-sectional study involving a comprehensive ophthalmologic evaluation using spectral domain-optical coherence tomography for retinal segmentation analysis.
- Detailed autoimmune disease specialist evaluation to assess SLE activity and systemic involvement.
- Multiple linear regression analysis to control for confounders and multivariable analysis for SLE-specific factors.
Main Results:
- SLE patients exhibited significantly thinner pRNFL globally and in specific sectors compared to controls.
- Chronic medications for hypercholesterolemia, hypertension, and anticoagulants were associated with pRNFL thinning in SLE patients.
- SLE patients showed significant thinning of the photoreceptor layer, associated with shorter disease duration, higher disease activity, neuropsychiatric involvement, and cardiovascular risk factors.
Conclusions:
- Patients with SLE demonstrate early signs of retinal neurodegeneration, characterized by reduced photoreceptor layer and pRNFL thickness.
- These neurodegenerative changes are more pronounced in SLE patients with greater cardiovascular risk or neuropsychiatric symptoms.
- Retinal imaging may serve as a potential biomarker for neurological involvement in SLE.
