Uveitis associated with systemic lupus erythematosus
Introduction
Introduction to uveitis associated with systemic lupus erythematosus Systemic lupus erythematosus (systemiclupuserythematosus) is an autoimmune connective tissue disease that is mainly mediated by immune complexes. It is typically characterized by multiple autoantibody productions and multiple systems, multiple organ involvement, and ocular dermatitis in the eye. Sjögren syndrome, keratitis, scleritis, anterior uveitis, retinal vasculopathy, etc. basic knowledge The proportion of illness: 0.005% Susceptible people: women Mode of infection: non-infectious Complications: vasculitis
Cause
Causes of uveitis associated with systemic lupus erythematosus
(1) Causes of the disease
Unexplained causes, extensive research suggests that genetic factors, immune factors, infectious factors, drugs, etc. may play a role in their pathogenesis.
(two) pathogenesis
Although the exact pathogenesis of this disease is not fully understood, it has been found to be associated with HLA-DR2 and HLA-DR3 antigens, especially with the HLA-DRBl*0301 allele and the HLADQ*0501 allele. HLA-B8 antigen is closely related to female patients, while HLA-B7 antigen and HLA-B8.42 are associated with discoid erythema; autoreactive T cells stimulate autoreactive B cell differentiation and produce autoantibodies, the latter through III Type of allergic reaction (immune complex type) causes damage to multiple systems and multiple organs; after viral infection, the genome is integrated into the genome of the host cell, and the alteration of the gene can induce antibodies against the altered host DNA, infecting the cell surface. Viral antigens can cause changes in cell membranes, thereby inducing humoral immune responses against these infected cells; both drug and environmental factors can cause damage to the body's structure, causing immune responses and multiple organ damage.
The immunological features of systemic lupus erythematosus are decreased inhibitory T cell function, polyclonal B cell activation, hyperimmune globulinemia and autoantibody formation. Its autoantibodies include antinuclear antibodies, anti-single-stranded DNA antibodies (anti-ssDNA antibodies). An anti-double-stranded DNA antibody or an anti-natural DNA antibody (anti-dsDNA antibody or anti-nDNA antibody), an antibody against cytoplasmic components, which are deposited in various organs and tissues via blood circulation to form an immune complex and activate complement. Systemic, causing inflammatory reactions and tissue damage, vasculitis is its initial and most basic pathophysiological changes.
Prevention
Uveitis prevention associated with systemic lupus erythematosus
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Systemic lupus erythematosus complicated with uveitis complications Complications vasculitis
Retinal hemorrhage and vasculitis are more common.
Symptom
Systemic lupus erythematosus associated with uveitis symptoms Common symptoms Joint pain uveitis discoid erythema visual field defect scleral outer inflammation retinal hemorrhagic nephrotic syndrome edema posterior optic neuritis keratitis
Eye lesion
(1) uveitis: uveitis caused by systemic lupus erythematosus, mainly manifested as retinal vasculitis and choroidal vasculitis, can also cause non-granulomatous iridocyclitis, choroiditis and so on.
Retinal vasculitis is usually occlusive inflammation. The classic retinal blepharospasm is the microinfarction of the optic nerve fiber layer caused by retinal arterioles or terminal arterial occlusion. This lesion can be accompanied by obvious symptoms, involving the macular area. Causes severe vision loss, unlike other cotton wool spots caused by it, it is not easy to cause retinal hemorrhage, fluorescein fundus angiography found that cotton wool plaque is equivalent to the non-perfused area of the retina.
Although occlusive retinal vasculitis mainly involves the retinal artery, it can also involve the retinal vein; although the small artery is easily involved, the central retinal artery can also be involved; in some patients, capillary occlusion such as diabetic retinopathy can still occur.
Other manifestations of retinal vasculitis and vascular lesions may also occur, such as retinal vascular sheath, retinal hemorrhage, microaneurysm, retinal neovascular membrane, and the like.
Although anterior uveitis can occur alone, it is often rare and often accompanied by scleritis and secondary glaucoma.
(2) Neuro-ophthalmology: This disease can cause a variety of neuro-ophthalmologic abnormalities, such as transient erythema, cortical blindness, visual field defects, optic neuritis, retrobulbar optic neuritis, ischemic optic neuropathy, optic disc edema, optic atrophy , strabismus, illusion, cerebral pseudotumor, occipital cerebral infarction, etc.
(3) Other changes:
1 eyelids: redness and swelling of the eyelids, discoid erythema, scaly papules, etc.
2 conjunctival and keratopathy: about 20% of patients with conjunctival and keratopathy, mainly for secondary Sjögren syndrome or keratoconjunctivitis sicca, 6.5% to 88% of patients with punctate corneal damage, about 8% Patients with recurrent conjunctivitis, some patients may have subepithelial fibrosis and conjunctival shrinkage, a small number of patients may have deep interstitial keratitis, corneal neovascularization.
3 scleritis and scleral inflammation: scleritis is often manifested as anterior scleritis or nodular scleritis, patients generally do not have necrotizing scleritis, so the prognosis is better, scleral inflammation is rare, usually benign, there are Self-limiting, the prognosis is better.
2. Whole body performance
(1) General performance: Most patients have non-specific systemic manifestations such as fever, fatigue, weight loss, and joint pain.
(2) Oral mucosa and skin changes: about 85% of patients have skin lesions, of which skin erythema is the most common, typically characterized by butterfly erythema (cheek, erythema of the nose root merged into a butterfly shape), flat or slightly raised, Discoid erythema often has keratinized scaly and hair follicle blockage, skin ulcers, fragmented hemorrhage, purpuric skin lesions, hair loss, maculopapular rash, etc. Other rare changes include proliferative discoid lesions, large blisters, and urticaria-like Skin lesions, the above skin lesions are aggravated after sun exposure, in addition, 26% to 40% of patients have painless mouth ulcers.
(3) Arthritis: Arthritis is a common initial manifestation. About 85% of patients have such lesions. Arthritis often has obvious pain or tenderness. It can be migratory polyarthritis, generally does not appear. Joint deformation.
(4) Kidney lesions: About half of the patients have kidney damage, which may be characterized by nephrotic syndrome or glomerulonephritis, membranous glomerular disease, focal proliferative nephritis, diffuse proliferative nephritis, etc. Lesions are one of the leading causes of death in patients.
(5) Neurological diseases: About one-third of patients have neuropsychiatric changes, which are manifested as epilepsy, organic disease, brain syndrome, psychosis, and transverse neuromyelitis, peripheral neuropathy and cranial nerve palsy.
(6) Heart disease: About 20% of patients have heart disease, which can be manifested as pericarditis, myocarditis and Libman-Sacks endocarditis. The latter disease is often associated with antiphospholipid antibodies.
(7) Other changes: patients may have pleurisy, pneumonia, hepatosplenomegaly, lymphadenopathy, etc.
Examine
Examination of uveitis associated with systemic lupus erythematosus
The diagnosis of this disease is mainly based on clinical manifestations and blood, urine and immunological examination, anti-nuclear antibodies appear in 95% of patients, therefore, this test is a good screening test, but because of this antibody can also appear In other rheumatic diseases, autoimmune liver diseases and thyroid diseases, it is not specific, and the specificity tests are anti-dsDNA antibodies and anti-Sm antigen antibodies.
Fluorescein fundus angiography can detect retinal microvascular and arteriole leakage, vascular wall staining, microaneurysm, capillary perfusion, cystoid macular edema, retinal neovascularization, etc. These changes are caused by other retinal vasculitis There is no essential difference in the change, and there is no significant value in the diagnosis of this disease. However, for patients with confirmed diagnosis, retinal vasculitis is found in fluorescein fundus angiography, which often indicates that the patient has systemic active inflammation, and the retinal non-perfusion and retinal neoplasia are shown by angiography. Vascular and retinal edema are also important in guiding clinical treatment, such as determining whether laser surgery is required.
Diagnosis
Diagnosis and differentiation of uveitis associated with systemic lupus erythematosus
Ocular manifestations usually occur after skin and other systemic lesions. It is generally not difficult to diagnose these patients. However, eye lesions may occasionally occur before other lesions occur, which may cause difficulties in diagnosis. Therefore, young patients with cotton plaque and bleeding may occur. The possibility of the disease should be taken into account. Consultation with a rheumatologist or physician will help diagnose the disease.
The ocular lesions caused by this disease should be associated with diseases that cause retinal vasculitis such as Behcet's disease uveitis, syphilitic uveitis, nodular polyarteritis, Takayasu disease, Wegener granulomatosis, etc. Identification of inflammation, such as patients with clear systemic disease, generally not difficult to distinguish with other diseases, such as patients with retinal vasculitis appear before systemic disease, you need to carry out relevant laboratory tests, and need to follow-up observation and other Specialist consultation, the retinal cotton plaque of this disease should also be differentiated from retinopathy caused by diabetes and hypertension and radioactive retinopathy.
