Skip to main content
Top
Published in: BMC Ophthalmology 1/2020

01-12-2020 | Glaucoma | Research article

Risks of ophthalmic disorders in patients with systemic lupus erythematosus – a secondary cohort analysis of population-based claims data

Authors: Chun-Shuo Hsu, Chia-Wen Hsu, Ming-Chi Lu, Malcolm Koo

Published in: BMC Ophthalmology | Issue 1/2020

Login to get access

Abstract

Background

Systemic lupus erythematosus (SLE) can directly affect various part of the ocular system, but there was no comprehensive analysis of ophthalmic disorders of patients with SLE using population-based data. The aim of this study was to investigate the frequency and prevalence of ophthalmic disorders for ophthalmologist visits in adult patients with SLE and to evaluate the risk of dry eye syndrome, cataracts, glaucoma, episcleritis and scleritis, and retinal vascular occlusion in these patients.

Methods

The Taiwan’s National Health Insurance Research Database was used to assemble a SLE cohort consisting of newly diagnosed SLE between 2000 and 2012. A comparison cohort was also sampled from the same database and it consisted of 10 patients without SLE for each patient with SLE, based on frequency matching for sex, five-year age interval, and index year. Both cohorts were followed until either the study outcomes have occurred or the end of the follow-up period.

Results

Patients with SLE (n = 521) exhibited a significantly higher prevalence (68.1% vs. 60.5%, P = 0.001) and frequency (median 5.51 vs. 1.71 per 10 years, P <  0.001) for outpatient ophthalmologist visits compared with patients without SLE. The risk of dry eye syndrome (adjusted incidence rate ratio [IRR] 4.45, P <  0.001), cataracts (adjusted IRR 3.18, P <  0.001), and glaucoma (adjusted IRR 2.23, P = 0.002) were significantly higher in patients with SLE. In addition, the risk of several SLE related ophthalmic disorders, including episcleritis and scleritis (adjusted IRR 6.11, P <  0.001) and retinal vascular occlusion (adjusted IRR 3.81, P = 0.023) were significantly higher in patients with SLE.

Conclusions

The increased risk of dry eye syndrome, cataracts, glaucoma, episcleritis and scleritis, and retinal vascular occlusion in patients with SLE deserves vigilance.
Literature
1.
go back to reference Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet. 2014;384:1878–88.CrossRef Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet. 2014;384:1878–88.CrossRef
2.
go back to reference Sivaraj RR, Durrani OM, Denniston AK, Murray PI, Gordon C. Ocular manifestations of systemic lupus erythematosus. Rheumatology (Oxford). 2007;46:1757–62.CrossRef Sivaraj RR, Durrani OM, Denniston AK, Murray PI, Gordon C. Ocular manifestations of systemic lupus erythematosus. Rheumatology (Oxford). 2007;46:1757–62.CrossRef
3.
go back to reference Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol. 2016;100:135–41.CrossRef Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol. 2016;100:135–41.CrossRef
4.
go back to reference Dammacco R. Systemic lupus erythematosus and ocular involvement: an overview. Clin Exp Med. 2018;18:135–49.CrossRef Dammacco R. Systemic lupus erythematosus and ocular involvement: an overview. Clin Exp Med. 2018;18:135–49.CrossRef
5.
go back to reference Zhang L, Liu JJ, Li MT. Herpes simplex virus type 1 encephalitis and unusual retinitis in a patient with systemic lupus erythematosus. Lupus. 2013;22:1403–8.CrossRef Zhang L, Liu JJ, Li MT. Herpes simplex virus type 1 encephalitis and unusual retinitis in a patient with systemic lupus erythematosus. Lupus. 2013;22:1403–8.CrossRef
6.
go back to reference El-Shereef RR, Mohamed AS, Hamdy L. Ocular manifestation of systemic lupus erythematosus. Rheumatol Int. 2013;33:1637–42.CrossRef El-Shereef RR, Mohamed AS, Hamdy L. Ocular manifestation of systemic lupus erythematosus. Rheumatol Int. 2013;33:1637–42.CrossRef
7.
go back to reference Stafford-Brady FJ, Urowitz MB, Gladman DD, Easterbrook M. Lupus retinopathy. Patterns, associations, and prognosis. Arthritis Rheum. 1998;31:1105–10.CrossRef Stafford-Brady FJ, Urowitz MB, Gladman DD, Easterbrook M. Lupus retinopathy. Patterns, associations, and prognosis. Arthritis Rheum. 1998;31:1105–10.CrossRef
8.
go back to reference Teoh SC, Yap EY, Au Eong KG. Neuro-ophthalmological manifestations of systemic lupus erythematosus in Asian patients. Clin Exp Ophthalmol. 2001;29:213–6.CrossRef Teoh SC, Yap EY, Au Eong KG. Neuro-ophthalmological manifestations of systemic lupus erythematosus in Asian patients. Clin Exp Ophthalmol. 2001;29:213–6.CrossRef
9.
go back to reference Nguyen QD, Uy HS, Akpek EK, Harper SL, Zacks DN, Foster CS. Choroidopathy of systemic lupus erythematosus. Lupus. 2000;9:288–98.CrossRef Nguyen QD, Uy HS, Akpek EK, Harper SL, Zacks DN, Foster CS. Choroidopathy of systemic lupus erythematosus. Lupus. 2000;9:288–98.CrossRef
11.
go back to reference Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.CrossRef Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.CrossRef
12.
go back to reference Zhang T, Xie X, Lu F. Primary open-angle glaucoma: neuroendocrine-immune disorder? Med Hypotheses. 2014;83:514–5.CrossRef Zhang T, Xie X, Lu F. Primary open-angle glaucoma: neuroendocrine-immune disorder? Med Hypotheses. 2014;83:514–5.CrossRef
13.
go back to reference Shimazaki J. Definition and diagnostic criteria of dry eye [in Japanese]. Ganka. 1995;37:765–70. Shimazaki J. Definition and diagnostic criteria of dry eye [in Japanese]. Ganka. 1995;37:765–70.
14.
go back to reference Hung KC, Hsueh PY, Wang NK, Su WW, Tan HY. Transient myopic shifting in systemic lupus erythematosus. Lupus. 2011;20:334–5.CrossRef Hung KC, Hsueh PY, Wang NK, Su WW, Tan HY. Transient myopic shifting in systemic lupus erythematosus. Lupus. 2011;20:334–5.CrossRef
15.
go back to reference Guerriero S, Ciracì L, Cardia G, Vetrugno M. Transient myopic shift as the presenting symptom of systemic lupus erythematosus: a UBM study. Ocul Immunol Inflamm. 2010;18:383–4.CrossRef Guerriero S, Ciracì L, Cardia G, Vetrugno M. Transient myopic shift as the presenting symptom of systemic lupus erythematosus: a UBM study. Ocul Immunol Inflamm. 2010;18:383–4.CrossRef
16.
go back to reference Lin HJ, Wei CC, Chang CY, Chen TH, Hsu YA, Hsieh YC, et al. Role of chronic inflammation in myopia progression: clinical evidence and experimental validation. EBioMedicine. 2016;10:269–81.CrossRef Lin HJ, Wei CC, Chang CY, Chen TH, Hsu YA, Hsieh YC, et al. Role of chronic inflammation in myopia progression: clinical evidence and experimental validation. EBioMedicine. 2016;10:269–81.CrossRef
17.
go back to reference Hsiao YP, Tsai JD, Muo CH, Tsai CH, Sung FC, Liao YT, et al. Atopic diseases and systemic lupus erythematosus: an epidemiological study of the risks and correlations. Int J Environ Res Public Health. 2014;11:8112–22.CrossRef Hsiao YP, Tsai JD, Muo CH, Tsai CH, Sung FC, Liao YT, et al. Atopic diseases and systemic lupus erythematosus: an epidemiological study of the risks and correlations. Int J Environ Res Public Health. 2014;11:8112–22.CrossRef
18.
go back to reference Seth G, Chengappa KG, Misra DP, Babu R, Belani P, Shanoj KC, et al. Lupus retinopathy: a marker of active systemic lupus erythematosus. Rheumatol Int. 2018;38:1495–501.CrossRef Seth G, Chengappa KG, Misra DP, Babu R, Belani P, Shanoj KC, et al. Lupus retinopathy: a marker of active systemic lupus erythematosus. Rheumatol Int. 2018;38:1495–501.CrossRef
19.
go back to reference Kharel Sitaula R, Shah DN, Singh D. Role of lupus retinopathy in systemic lupus erythematosus. J Ophthalmic Inflamm Infect. 2016;6:15.CrossRef Kharel Sitaula R, Shah DN, Singh D. Role of lupus retinopathy in systemic lupus erythematosus. J Ophthalmic Inflamm Infect. 2016;6:15.CrossRef
20.
go back to reference Jensen JL, Bergem HO, Gilboe IM, Husby G, Axéll T. Oral and ocular sicca symptoms and findings are prevalent in systemic lupus erythematosus. J Oral Pathol Med. 1999;28:317–22.CrossRef Jensen JL, Bergem HO, Gilboe IM, Husby G, Axéll T. Oral and ocular sicca symptoms and findings are prevalent in systemic lupus erythematosus. J Oral Pathol Med. 1999;28:317–22.CrossRef
21.
go back to reference Alderaan K, Sekicki V, Magder LS, Petri M. Risk factors for cataracts in systemic lupus erythematosus (SLE). Rheumatol Int. 2015;35:701–8.CrossRef Alderaan K, Sekicki V, Magder LS, Petri M. Risk factors for cataracts in systemic lupus erythematosus (SLE). Rheumatol Int. 2015;35:701–8.CrossRef
22.
go back to reference Lin HC, Chien CW, Hu CC, Ho JD. Comparison of comorbid conditions between open-angle glaucoma patients and a control cohort: a case-control study. Ophthalmology. 2010;117:2088–95.CrossRef Lin HC, Chien CW, Hu CC, Ho JD. Comparison of comorbid conditions between open-angle glaucoma patients and a control cohort: a case-control study. Ophthalmology. 2010;117:2088–95.CrossRef
23.
go back to reference Chan PC, Yu CH, Yeh KW, Horng JT, Huang JL. Comorbidities of pediatric systemic lupus erythematosus: a 6-year nationwide population-based study. J Microbiol Immunol Infect. 2016;49:257–63.CrossRef Chan PC, Yu CH, Yeh KW, Horng JT, Huang JL. Comorbidities of pediatric systemic lupus erythematosus: a 6-year nationwide population-based study. J Microbiol Immunol Infect. 2016;49:257–63.CrossRef
24.
go back to reference Sainz de la Maza M, Foster CS, Jabbur NS. Scleritis associated with systemic vasculitic diseases. Ophthalmology. 1995;102:687–92.CrossRef Sainz de la Maza M, Foster CS, Jabbur NS. Scleritis associated with systemic vasculitic diseases. Ophthalmology. 1995;102:687–92.CrossRef
25.
go back to reference Frith P, Burge SM, Millard PR, Wojnarowska F. External ocular findings in lupus erythematosus: a clinical and immunopathological study. Br J Ophthalmol. 1990;74:163–7.CrossRef Frith P, Burge SM, Millard PR, Wojnarowska F. External ocular findings in lupus erythematosus: a clinical and immunopathological study. Br J Ophthalmol. 1990;74:163–7.CrossRef
26.
go back to reference Gao N, Li MT, Li YH, Zhang SH, Zhang SH, Dai RP, Zhang SZ, et al. Retinal vasculopathy in patients with systemic lupus erythematosus. Lupus. 2017;26:1182–9.CrossRef Gao N, Li MT, Li YH, Zhang SH, Zhang SH, Dai RP, Zhang SZ, et al. Retinal vasculopathy in patients with systemic lupus erythematosus. Lupus. 2017;26:1182–9.CrossRef
27.
go back to reference Asherson RA, Merry P, Acheson JF, Harris EN, Hughes GR. Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the 'primary' antiphospholipid syndrome. Ann Rheum Dis. 1989;48:358–61.CrossRef Asherson RA, Merry P, Acheson JF, Harris EN, Hughes GR. Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the 'primary' antiphospholipid syndrome. Ann Rheum Dis. 1989;48:358–61.CrossRef
Metadata
Title
Risks of ophthalmic disorders in patients with systemic lupus erythematosus – a secondary cohort analysis of population-based claims data
Authors
Chun-Shuo Hsu
Chia-Wen Hsu
Ming-Chi Lu
Malcolm Koo
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2020
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-020-01360-w

Other articles of this Issue 1/2020

BMC Ophthalmology 1/2020 Go to the issue