Article

Clinical characteristics of 4 cases of scleritis associated with systemic lupus erythematosus

  • WANG Le ,
  • YANG Yue ,
  • JIA Yuan ,
  • MIAO Heng ,
  • ZHOU Yun-shan ,
  • ZHANG Xiao-ying
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  • (1. Department of Rheumatology and Immunology, 2. Department of Ophtalmology,Peking University People’s Hospital, Beijing 100044, China)

Online published: 2016-12-18

Supported by

Supported by the National Natural Science Foundation of China (31300721) and the Research Fund for the Doctoral Program of Higher Education of China (20130001120066)

Abstract

Episcleritis and scleritis are relatively rare ocular diseases, which are commonly associated with rheumatic diseases including systemic lupus erythematosus (SLE). To investigate clinical and laboratory features of SLEassociated episcleritis and scleritis, we now report 4 cases of inpatients who were diagnosed with episcleritis or scleritis secondary to SLE from September 2005 to July 2016 in the Department of Rheumatology and Immunology in Peking University People’s Hospital. Demographic, clinical and laboratory characteristics were summarized together with the treatment regimen and the prognosis; the literature was reviewed. There were 3 female and 1 male patients. The average age was (49.0±23.8) years and the mean duration of SLE at the onset of episcleritis or scleritis was (2.1±1.4) years. In addition to the eye involvement, the patients had mucocutaneous manifestations, serositis, lupus nephritis and interstitial pneumonia simultaneously;  in the past, 1 patient experienced arthritis, 2 presented Raynaud’s phenomenon, and 2 had hematologic involvement. All the patients had antinuclear antibody (ANA) of high titer. The anti double-stranded DNA (ds-DNA) antibody titers were increased in 2 patients. Three patients had positive anti-nucleosome antibody (ANuA) while the other 1 patient did not test it. The complement levels were decreased in 3 patients. The systemic lupus erythematosus disease activity index (SLEDAI) scores were more than 4 points in all the patients (ranging from 7-16), suggesting active disease. Ocular symptoms included pain, redness of the eye and tears. Ophthalmic examinations revealed 3 cases of episcleritis and 1 case of scleritis. Among the 4 patients, 2 patients expe-rienced ocular complications including decrease in vision and uveitis. All the patients were treated with systemic corticosteroids combined with hydroxycloroquine; 3 patients were treated with immunosuppres-sants (cyclophosphamide in 2 patients and leflunomide in 1 patient). All of the 4 patients received topical steroid and 1 patient received periocular injection of triamcinolone acetonide; 1 patient received topical nonsteroidal anti-inflammatory drug (NSAID).No recurrence of episcleritis or scleritis was observed during the follow-ups. As a conclusion, scleritis and episcleritis, although uncommon, may occur in patients with autoimmune rheumatic diseases including SLE. The occurrence of episcleritis and scleritis may suggest active disease of SLE. Ocular complications need to be aware of in the patients. Prompt diagnosis and treatment was associated with good visual outcomes in the follow-ups.

Cite this article

WANG Le , YANG Yue , JIA Yuan , MIAO Heng , ZHOU Yun-shan , ZHANG Xiao-ying . Clinical characteristics of 4 cases of scleritis associated with systemic lupus erythematosus[J]. Journal of Peking University(Health Sciences), 2016 , 48(6) : 1081 -1085 . DOI: 10.3969/j.issn.1671-167X.2016.06.028

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