Microvascular findings in patients with systemic lupus erythematosus assessed by fundus photography with fluorescein angiography.

OBJECTIVES

Although a series of trials support systemic lupus erythematosus (SLE) is associated with increased atherosclerosis and cardiovascular events, the link between microvascular structural change and the disease activity of SLE is not defined. We measured retinal microvasculature change by fundus photography with fluorescein angiography (FAG) and investigated the association between retinal vasculature and clinical parameters of SLE.

METHODS

Fifty SLE patients and fifty healthy controls were included. Morphometric and quantitative features of the capillary image including retinal vascular sign and vessel diameters were measured with fundus photography and FAG. Information concerning SLE duration, cumulative dose of steroids and/or immunosuppressive drug intake was recorded, and autoantibodies were checked. SLE activity was assessed by SLE disease activity index (SLEDAI).

RESULTS

The mean central retinal arteriolar equivalent (CRAE) was 89.7±14.5 μm in SLE patients, showing narrower arteriole than that of controls (102.2±11.3 μm). The mean central retinal venular equivalents (CRVE) was 127.7±14.8 μm in SLE patients, also, narrower than that of controls (144.1±14.2 μm), but both reached no statistical significance (p=0.154, p=0.609, respectively). Retinopathy was found in 26% of SLE patients. SLE patients with retinopathy were older than those without it, but reached no statistical significance. Disease duration, antidsDNA, and complement levels had no effect on the presence of retinopathy. SLE patients with retinopathy had a tendency to have higher cumulative steroid doses, hsCRP and IgG aCL levels than those without retinopathy. With multiple regression analysis, hsCRP and IgG aCL were identified as contributing factors to the decreased CRAE, whereas no contributing factor was found to CRVE.

CONCLUSIONS

Retinopathy and retinal arteriolar narrowing were more common in SLE patients, and retinal arteriolar diameter had significant correlation with hsCRP and IgG aCL levels. Retinal imaging is a comparative method for the assessment of microvascular findings of SLE patients.