系统性红斑狼疮并发巩膜炎临床分析

Objective: To explore the clinical characteristics, treatment and prognosis of scleritis secondary to systemic lupus erythematosus (SLE). Methods: All the 1456 patients diagnosed as SLE in Peking University People's Hospital between September 2005 and July 2016 were included. Among them, 4 patients were identified as episcleritis or scleritis. The clinical and laboratory features were summarized in together with the treatment regimen and the prognosis. Results: Among the 4 patients, 3 were female and 1 was male. The average age was (49±23.8) years and the mean duration of SLE at the onset of episcleritis or scleritis was (2.1±1.4) years. Ocular symptoms included pain, redness of the eye and tears. In addition to the eye involvement, the patients had serositis, lupus nephritis or interstitial pneumonia. The complement levels were decreased in 3 patients (3/4); the anti-double stranded DNA (ds-DNA) antibody titers were increased in 2 patients; the SLEDAI score were more than 4 points in all the patients. Ophthalmic examination revealed 3 cases of episcleritis and 1 case of scleritis, 2 cases of unilateral and 2 cases of bilateral involvement. All the patients were treated with systemic corticosteroids combined with hydroxychloroquine, 3 patients were treated with immunosuppressants (cyclophosphamide in 2 and leflunomide in 1). All patients received topical steroid and 1 patient received juxtaglomerular injection of triamcinolone acetonide. No recurrence of episcleritis or scleritis was observed during the follow-ups. Conclusion: While uncommon, scleritis and episcleritis may occur in patients with autoimmune rheumatic diseases including SLE. Prompt diagnosis and treatment was associated with good outcomes in the follow-ups.