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Neuro‐ophthalmologic manifestations of systemic lupus erythematosus: a systematic review
Author(s) -
Man Bik Ling,
Mok Chi Chiu,
Fu Yat Pang
Publication year - 2014
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12337
Subject(s) - medicine , rituximab , azathioprine , neuromyelitis optica , antiphospholipid syndrome , optic neuritis , dermatology , plasmapheresis , immunosuppression , concomitant , pediatrics , immunology , multiple sclerosis , surgery , disease , lymphoma , antibody
Herein we summarize the clinical presentation, treatment and outcome of neuro‐ophthalmologic manifestations in patients with systemic lupus erythematosus ( SLE ). We performed a systematic review of the neuro‐ophthalmologic manifestations of SLE reported in the English literature from 1970 to 2010 by a Medline search. The prevalence of neuro‐ophthalmologic manifestations is 3.6% in adult and 1.6% in childhood SLE patients. Neuro‐ophthalmologic manifestations of SLE are highly variable, with the commonest presentation being optic neuritis, followed by myasthenia gravis, visual field defects and pseudotumor cerebri. The underlying pathology was thought to be either SLE activity or its vascular complications. Most neuro‐ophthalmologic manifestations of SLE are responsive to high‐dose glucocorticoids. Anticoagulation is indicated when there is concomitant antiphospholipid syndrome. SLE ‐related neuromyelitis optica is often refractory to treatment and 92% of patients require multiple immunosuppressive protocols. Neuro‐ophthalmologic manifestations of SLE are uncommon but heterogeneous. The prognosis of neuro‐ophthalmologic manifestations in SLE is generally good because of their rapid response to glucocorticoids. Relapses of these manifestations may be reduced by the use of maintenance immunosuppression. Cyclophosphamide, azathioprine, plasmapheresis, intravenous immunoglobulin and rituximab can be considered in glucocorticoid‐dependent or refractory cases. Anticoagulation is indicated when there is concomitant antiphospholipid syndrome.