Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, CP 14000, Mexico City, CP, Mexico.
Department of Ophthalmology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, CP 14000, Mexico City, CP, Mexico.
Rheumatol Int. 2019 Mar;39(3):489-495. doi: 10.1007/s00296-019-04242-7. Epub 2019 Jan 31.
Ocular involvement is present in 50-60% of granulomatosis with polyangiitis (GPA) patients and can affect any part of the ocular globe. The present study describes ophthalmologic manifestations, association with systemic symptoms, disease activity and damage in GPA. A cross-sectional study was conducted including patients with GPA who underwent rheumatologic and ophthalmologic evaluation. Demographics, comorbidities, ophthalmologic symptoms, serologic markers, radiographic studies, disease activity and damage were assessed. Descriptive statistics, correlation, univariable logistic regression analyses, Student's t, Mann-Whitney U, Chi-square and Fisher's exact tests were performed. Fifty patients were included, 60% female, the median age was 56 years, disease duration 72.5 months. Nineteen (38%) patients had ocular manifestations at GPA diagnosis, scleritis being the most frequent; 27 (54%) patients presented ocular involvement during follow-up, repeated scleritis and dacryocystitis being the most common manifestations. Concomitant ophthalmic and sinonasal involvement was present in 12 (24%). Ocular and ENT damage occurred in 58% and 70%, respectively. Epiphora and blurred vision were the most frequent symptoms; scleromalacia and conjunctival hyperemia (27%) the most frequent clinical abnormalities. Ocular involvement at diagnosis was associated with concomitant ocular and sinonasal involvement at follow-up (OR 4.72, 95% CI 1.17-19.01, p = 0.01). Ocular involvement at follow-up was associated with age at GPA diagnosis (OR 0.94, 95% CI 0.90-0.99, p = 0.03), VDI (OR 1.29, 95% CI 1.03-1.61, p = 0.02), and ENT damage (OR 5.27, 95% CI 1.37-20.13, p = 0.01). In GPA, ocular involvement is frequent, therefore, non-ophthalmologist clinicians should be aware of this manifestation to reduce the risk of visual morbidity and organ damage.
眼病变在肉芽肿性多血管炎（GPA）患者中占 50-60%，可影响眼球的任何部位。本研究描述了 GPA 的眼科表现、与全身症状的关系、疾病活动度和损害。进行了一项横断面研究，包括接受风湿病学和眼科评估的 GPA 患者。评估了人口统计学、合并症、眼科症状、血清标志物、影像学研究、疾病活动度和损害。进行了描述性统计、相关性、单变量逻辑回归分析、学生 t 检验、Mann-Whitney U 检验、卡方检验和 Fisher 确切检验。共纳入 50 例患者，其中 60%为女性，中位年龄为 56 岁，疾病病程为 72.5 个月。19 例（38%）患者在 GPA 诊断时存在眼部表现，最常见的是巩膜炎；27 例（54%）患者在随访期间出现眼部受累，最常见的表现是复发性巩膜炎和泪囊炎。12 例（24%）患者同时存在眼部和鼻-鼻窦受累。58%和 70%的患者分别发生眼部和 ENT 损害。溢泪和视力模糊是最常见的症状；巩膜软化和结膜充血（27%）是最常见的临床异常。诊断时的眼部受累与随访时的同时眼部和鼻-鼻窦受累相关（OR 4.72，95%CI 1.17-19.01，p=0.01）。随访时的眼部受累与 GPA 诊断时的年龄（OR 0.94，95%CI 0.90-0.99，p=0.03）、VDI（OR 1.29，95%CI 1.03-1.61，p=0.02）和 ENT 损害（OR 5.27，95%CI 1.37-20.13，p=0.01）相关。在 GPA 中，眼部受累很常见，因此，非眼科临床医生应了解这种表现，以降低视力受损和器官损害的风险。
