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Wolf E, Wicklein R, Aly L, Schmaderer C, Afzali AM, Mardin C, Korn T, Hemmer B, Hofauer B, Knier B. Optical coherence tomography angiography suggests different retinal pathologies in multiple sclerosis and Sjögren's syndrome. J Neurol 2024:10.1007/s00415-024-12414-0. [PMID: 38743089 DOI: 10.1007/s00415-024-12414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND While retinal vessel changes are evident in the eyes of patients with relapsing-remitting multiple sclerosis (RRMS), changes in the vasculature of possible MS mimics such as primary Sjögren's syndrome (pSS) remain to be determined. We investigated the potential of retinal optical coherence tomography (OCT) angiography (OCTA) as diagnostic tool to differentiate between patients with RRMS and pSS. METHODS This cross-sectional study included patients with RRMS (n = 36), pSS (n = 36) and healthy controls (n = 30). Participants underwent clinical examination, assessment of visual acuity, retinal OCT, OCTA, and serum markers of glial and neuronal damage. We investigated the associations between OCTA parameters, visual functions, and serum markers. Eyes with a history of optic neuritis (ON) were excluded from analysis. RESULTS We observed a significant thinning of the combined ganglion cell and inner plexiform layer in the eyes of patients with RRMS but not with pSS, when compared to healthy controls. Retinal vessel densities of the superficial vascular complex (SVC) were reduced in both patients with RRMS and pSS. However, retinal vessel rarefication of the deep vascular complex (DVC) was only evident in patients with pSS but not RRMS. Using multivariate regression analysis, we found that DVC vessel loss in pSS patients was associated with worse visual acuity. CONCLUSIONS Compared to patients with RRMS, rarefication of deep retinal vessels is a unique characteristic of pSS and associated with worse visual function. Assuming a disease-specific retinal vessel pathology, these data are indicative of a differential affliction of the gliovascular complex in the retina of RRMS and pSS patients.
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Affiliation(s)
- Elisabeth Wolf
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ali Maisam Afzali
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Otorhinolaryngology/Head and Neck Surgery, Tirol Kliniken, Universitätskliniken Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Benjamin Knier
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Department of Neurology, Diakonie-Klinkum Schwäbisch Hall, Schwäbisch Hall, Germany.
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Lin B, Chung CH, Sun CA, Chen CL, Chien WC. Increased Risk of Glaucoma in Patients with Sjögren's Syndrome: A Nationwide Population-Based Cohort Study. Ophthalmic Epidemiol 2024; 31:134-144. [PMID: 37183436 DOI: 10.1080/09286586.2023.2213766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The risk of glaucoma in patients suffering from Sjögren's syndrome has not been elucidated. We aimed for evaluating the absolute incidence as well as the relative risk of glaucoma in patients with SS at the level of the whole country population. METHODS We conducted a retrospective cohort study using a national health insurance database in Taiwan from 2000 to 2013. We used International Classification of Diseases, Ninth Revision, to categorise medical conditions for study group and comparison group. We used Cox proportional hazard regression analysis to determine adjusted hazard ratios (aHRs) of glaucoma between study and comparison group after adjusting for sex, age, and comorbidities. RESULTS Among 17,398 patients with primary Sjögren's syndrome, 133 patients were diagnosis with glaucoma during follow-up. Of the 69,592 non-primary Sjögren's syndrome patients, 429 patients developed glaucoma. Glaucoma risk was elevated in patients with primary Sjögren's syndrome than in the non-Sjögren's syndrome group (adjusted hazard ratio [HR] 2.274, 95% in the confidence interval [95% CI] 1.847-2.800; P < .001). CONCLUSIONS The risk of glaucoma among the population having Sjögren's syndrome was higher than those did not have Sjögren's syndrome. It indicated the necessity of regular examination for glaucoma in patients with Sjögren's syndrome.
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Affiliation(s)
- Bingsian Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
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Kiyat P, Karti O, Gercik Ö, Şak T. Choroidal, retinal, and optic nerve changes in rheumatoid arthritis and primary sjogren's syndrome patients: comparıson with each other and healthy subjects. Int Ophthalmol 2024; 44:24. [PMID: 38324105 DOI: 10.1007/s10792-024-02970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/04/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE The present study aims to evaluate the optic nerve, macula, and choroidal changes in both rheumatoid arthritis (RA) and primary Sjögren's syndrome (SjS) patients, and to compare these findings with age-matched healthy volunteers. METHODS This study included 46 RA patients, 33 primary SjS patients, and 37 age-matched healthy volunteers. All of the patients underwent a thorough ophthalmological examination, during which measurements of the retinal nerve fiber layer (RNFL), ganglion cell layer(GCL), and subfoveal choroidal thickness (CT) were taken using OCT (optical coherence tomography). The measurements taken from the right eye of each patient were used to compare among the groups. RESULTS RNFL thickness in superior quadrant was found to be statistically significantly thinner in the eyes with RA when compared to the control group (p = 0.022). In the nasal quadrant, the RNFL thickness was significantly thinner in patients with primary SjS compared to healthy individuals (p = 0.036). Also, the temporal quadrant RNFL was significantly thinner in RA patients than in the primary SjS patients (p = 0.033). GCL thickness was observed to be thinner in all quadrants of both RA and primary SjS groups compared to the control group. However, the difference was not found to be statistically significant. Subfoveal CT was observed to be thicker in RA and SjS groups compared to the control group, but this difference was also not statistically significant. CONCLUSION Systemic autoimmune diseases like RA and primary SjS can lead to a decrease in RNLF and GCL thickness, which can impair visual acuity even in the absence of ocular symptoms. Therefore, monitoring changes in the optic nerve, retina, and choroid layer are crucial in these patients.
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Affiliation(s)
- Pelin Kiyat
- Department of Ophthalmology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, Kozağaç Mah., Özmen Sok., No:147, Buca, İzmir, Turkey.
| | - Omer Karti
- Department of Ophthalmology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, Kozağaç Mah., Özmen Sok., No:147, Buca, İzmir, Turkey
| | - Önay Gercik
- Department of Rheumatology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey
| | - Tuncer Şak
- Department of Rheumatology, İzmir Democracy University, Buca Seyfi Demirsoy Training and Research Hospital, İzmir, Turkey
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Liu R, Wang Y, Li Q, Xia Q, Xu T, Han T, Cai S, Luo S, Wu R, Shao Y. Optical Coherence Tomography Angiography Biomarkers of Retinal Thickness and Microvascular Alterations in Sjogren's Syndrome. Front Neurol 2022; 13:853930. [PMID: 35350402 PMCID: PMC8957855 DOI: 10.3389/fneur.2022.853930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the differences of retinal thickness (RT) and superficial vascular density (SVD) between patients with Sjogren's syndrome (SS) and healthy controls (HCs) using optical coherence tomography angiography (OCTA). Methods Individuals with SS and healthy controls were enrolled (n = 12 per group). An en-face OCTA scan was performed on each eye. Images were segmented into 9 subregions and macular RT and SVD were measured and compared between the 2 groups. Results Visual acuity (VA) differed significantly between patients with SS (24 eyes) and controls (24 eyes) (p < 0.001). In patients with SS, inner RT was reduced in the inner superior region, outer RT was reduced in the outer nasal (ON) region, and full RT was reduced in the ON region compared with the control group (p < 0.05). RT was negatively correlated with serum IgG level in the outer and full retina at ON regions (p < 0.05). SVD in the inner nasal, ON, and inner temporal regions was significantly lower in patients with SS than in control subjects (p < 0.05). SVD was positively correlated with full RT in the ON region in patients with SS (p < 0.05). The areas under the receiver operating characteristic (ROC) curves for the diagnostic sensitivity of outer RT and full RT in the ON region for SS were 0.828 (95% CI: 0.709–0.947) and 0.839 (95% CI: 0.715–0.963), respectively. Conclusions In patients with SS, retinal thinning in the macular area—which affects vision—can also reflect the severity of dry eyes in SS and has clinical value for assisted imaging diagnosis.
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Affiliation(s)
- Ren Liu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiuyu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Qiang Xia
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tian Xu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Han
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuang Cai
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuilin Luo
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Rui Wu
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
- Yi Shao
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Yang QC, Yao F, Li QY, Chen MJ, Zhang LJ, Shu HY, Liang RB, Pan YC, Ge QM, Shao Y. Ocular microvascular alteration in Sjögren syndrome. Quant Imaging Med Surg 2022; 12:1324-1335. [PMID: 35111627 DOI: 10.21037/qims-21-234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sjögren syndrome (SjS) is a systemic disease affecting exocrine, including ocular lacrimal, glands. It is uncertain whether ocular microvascular alterations are associated with this disease. In this study, we evaluated retinal and conjunctival microvascular changes in SjS patients using optical coherence tomography angiography (OCTA). METHODS Twelve SjS patients (24 eyes) and 12 normal controls (24 eyes) were recruited to this study. Three-dimensional conjunctival and retinal OCTA images of each eye were captured and microvascular density was calculated. Each image was analyzed by retinal area based on the early treatment of diabetic retinopathy study method (R, S, L, and I) hemisphere segmentation method (SR, SL, IL, and IR); and central wheel division method (C1-C6). Correlation analyses were used to look for associations between retinal and conjunctival microvascular densities. RESULTS Superficial and deep retinal layer microvascular density was decreased in SjS patients compared with normal controls (P<0.05). This significant difference was found in both superficial and deep layers in S, L, SL, IL and C1-C3 regions, and additionally in the I and SR regions in the superficial layer. Conversely, in the conjunctiva microvascular density was higher in SjS patients than in controls. In SjS patients, a significant negative correlation was found between conjunctival and both superficial (r=-0.641; P=0.025) and deep (r=-0.958; P<0.0001) microvascular densities. CONCLUSIONS The changed microvascular densities measured in deep and superficial retinal layers and in the conjunctiva demonstrate that OCTA is a promising method in differentiating the eyes from those with SjS.
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Affiliation(s)
- Qi-Chen Yang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Yao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Min-Jie Chen
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Rong-Bin Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Yi-Cong Pan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
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Hysa E, Cutolo CA, Gotelli E, Paolino S, Cimmino MA, Pacini G, Pizzorni C, Sulli A, Smith V, Cutolo M. Ocular microvascular damage in autoimmune rheumatic diseases: The pathophysiological role of the immune system. Autoimmun Rev 2021; 20:102796. [PMID: 33722750 DOI: 10.1016/j.autrev.2021.102796] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
Pathological eye involvement represents a quite common finding in a broad spectrum of autoimmune rheumatic diseases (ARDs). Ocular signs, often occur as early manifestations in ARDs, ranging from symptoms related to the mild dry eye disease to sight-threatening pathologies, linked to the immune response against retinal and choroidal vessels. Retinovascular damage driven by markedly inflammatory reactivity need a prompt diagnosis and treatment. Immune-complexes formation, complement activation and antibody-mediated endothelial damage seem to play a key role, particularly, in microvascular damage and ocular symptoms, occurring in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS). Conversely, early alterations of retinal and choroidal vessels in the asymptomatic patient, often detectable coincidentally, might be indicators of widespread vascular injury in other connective tissue diseases. Particularly, endothelin-induced hypoperfusion and pathological peri-choroidal extracellular matrix deposition, might be responsible for the micro-architectural alterations and loss of capillaries detected in systemic sclerosis (SSc). Instead, interferon alpha-mediated microvascular rarefaction, combined with endothelial lesions caused by specific autoantibodies and immune-complexes, appear to play a significant role in retinal vasculopathy associated to inflammatory idiopathic myopathies (IIM). The immuno-pathophysiological mechanisms of ocular microcirculatory damage associated with the major ARDs will be discussed under the light of the most recent achievements.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Carlo Alberto Cutolo
- Ophtalmology Clinic DiNOGMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy.
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Marco Amedeo Cimmino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Greta Pacini
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
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Neurodegeneration in systemic lupus erythematosus: layer by layer retinal study using optical coherence tomography. Int J Retina Vitreous 2020; 6:15. [PMID: 32337070 PMCID: PMC7171841 DOI: 10.1186/s40942-020-00219-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a chronic, autoimmune and multisystemic disease. Recent studies with functional and structural magnetic resonance imaging and cognitive tests report an unexpectedly high frequency of central nervous system involvement, even in patients with asymptomatic SLE. The purpose of this study was to identify early signs of retinal neurodegeneration by comparing the thickness of the peripapillary retinal nerve fiber layer (pRNFL) and all macular layers between patients with SLE without ophthalmologic manifestations and healthy controls. The effect of disease duration and systemic comorbidities was also studied. Methods Cross-sectional study, in which all participants underwent a complete ophthalmologic evaluation including retinal segmentation analysis with spectral domain-optical coherence tomography. Patients with SLE also received a detailed autoimmune disease specialist evaluation to assess the disease activity state and systemic involvement. For pRNFL thickness, the global and six peripapillary sectors were determined. Each macular layer thickness was determined in the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. A multiple linear regression analysis was performed to control for the effect of potential demographic, ophthalmic and systemic confounders. A second multivariable analysis, including patients with SLE only, was performed to assess the effect of disease-specific variables on the outcome measures. Results Sixty-eight eyes of 68 patients with SLE and 50 eyes of 50 healthy controls were considered. The pRNFL was significantly thinner in the SLE group globally (p = 0.026) and in the temporal superior (p = 0.007) and temporal (p = 0.037) sectors. In patients with SLE, chronic medication for hypercholesterolemia, hypertension and anticoagulants were associated with a significant thinning of the pRNFL. Patients with SLE presented significant thinning in the photoreceptor layer in five ETDRS areas (p < 0.05). Shorter disease duration was associated with greater photoreceptor thinning in all ETDRS subfields. Neuropsychiatric SLE, higher disease activity and cardiovascular risk factors were associated with a thinner photoreceptor layer. No differences were observed in overall retinal thickness or the remaining macular layers. Conclusion Patients with SLE present early signs of retinal neurodegeneration, as evidenced by a reduction in the photoreceptor layer and pRNFL. These signs are more pronounced in patients with higher cardiovascular risk burden or neuropsychiatric involvement.
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Baban B, Golubnitschaja O. The potential relationship between Flammer and Sjögren syndromes: the chime of dysfunction. EPMA J 2017; 8:333-338. [PMID: 29209436 PMCID: PMC5700012 DOI: 10.1007/s13167-017-0107-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/28/2017] [Indexed: 02/07/2023]
Abstract
Flammer syndrome (FS) is a term to blanket a cluster of vascular and nonvascular signs and symptoms linked to primary vascular dysregulation (PVD), increased sensitivity to various stimuli (stress, drugs, etc.) and altered sense regulation such as pain, smell and thirst perception. On one hand, disruption of blood barrier and homeostasis of the body are the main targets of vascular irregularity. Inflammation and immune disorders including autoimmunity are considered as a consequence of the abnormal vascular regulation processes. On the other hand, decreased thirst feeling typical for FS-affected individuals may lead to extensive body dehydration resulting in dry eye appearance and breast cancer (BC) risk, amongst others. To this end, recent research demonstrated FS as linked to BC development and progression into the metastatic disease. On the other side, Sjögren syndrome (SS) is an autoimmune disease characterised by a progressive sicca syndrome associated with the dry eye symptoms, specific immunologic complex and/or significant infiltrate at minor salivary gland biopsy. SS is relatively frequent, with a clinical diagnosis predominantly amongst women. Its physiopathology is a complex battery of both environmental and genetic factors. If left untreated, SS may be associated with and/or resulted in severe arthritis and the development of B cell lymphoma. In this mini-review, we summarise the facts and hypotheses connecting FS and SS symptoms together and mechanisms potentially overlapping in both syndromes. Unraveling the common denominators between these two syndromes not only providing more evidence for interaction between altered sense regulation, vascular dysregulation, immune system dysfunction but also focusing on the individual outcomes in terms of severity grade and potential complications exploring novel diagnostic, prognostic and treatment modalities. Multi-professional considerations presented here are an example how to effectively enter the new era of preventive, predictive and personalised medicine benefiting the patients and healthcare system as the whole.
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Affiliation(s)
- Babak Baban
- Department of Oral Biology, Dental College of Georgia, Augusta University, 1120, 15th St, CL 2140, GA 30912 Augusta, USA
- Department of Surgery/Section of Plastic Surgery, Augusta University, 1120, 15th St, CL 2140, GA 30912 Augusta, USA
- Department of Neurology, Medical College of Georgia, Augusta University, 1120, 15th St, CL 2140, GA 30912 Augusta, USA
| | - Olga Golubnitschaja
- Radiological clinic, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany
- Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
- Centre for Integrated Oncology, Cologne-Bonn, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
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