Lupus Retinopathy in Systemic Lupus Erythematosus: Prevalence, Phenotypic Spectrum, and Associations with Severe Disease Activity and Antiphospholipid Antibody Status
5 affiliations
- 1Department of Rheumatology, Bangladesh Medical University, Dhaka 1000, Bangladesh
- 2Department of Pediatric Rheumatology, Bangladesh Medical University, Dhaka 1000, Bangladesh
- 3Department of Ophthalmology, Bangladesh Medical University, Dhaka 1000, Bangladesh
- 4Combined Military Hospital, Dhaka 1206, Bangladesh
- 5Department of Medicine, MH Samorita Medical College, Dhaka 1208, Bangladesh
Abstract
Background/Objectives: Lupus retinopathy is an uncommon but clinically important manifestation of systemic lupus erythematosus (SLE) that may reflect systemic vascular injury and increased activity. However, data from South Asian populations are limited. To determine the prevalence, clinical spectrum, and factors associated with lupus retinopathy in patients with SLE, with particular emphasis on disease activity and antiphospholipid antibody (aPL) status. Methods: This hospital-based cross-sectional study included adults with SLE who met the 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology classification criteria and were consecutively recruited at a tertiary referral center in Bangladesh. All participants underwent comprehensive ophthalmological examinations, including dilated fundus examinations and fundus photography. Optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) were conducted as needed in the study. We evaluated disease activity using the SLE Disease Activity Index 2000 (SLEDAI-2K). We used logistic regression to examine the relationship between lupus retinopathy and other factors. We also analyzed the association between aPL status and retinopathy phenotype using Fisher’s exact test. Results: Among 159 patients with SLE, 18 (11.3%) had ocular involvement and 16 (10.1%) had lupus retinopathy. Of the 16 patients with retinopathy, 11 (68.8%) had mild, 2 (12.5%) had moderate, and 3 (18.8%) had severe disease; 3 (18.8%) had occlusive and 13 (81.3%) had non-occlusive; retinonocclusive systemic disease activity was independently associated with lupus retinopathy (adjusted odds ratio [aOR], 7.20; 95% confidence interval [CI], 1.78–29.11; p = 0.006). Renal involvement was not independently associated with retinopathy (aOR, 2.31; 95% CI, 0.56–9.58; p = 0.247). Among patients with available aPL results, aPL positivity was not significantly associated with lupus retinopathy (41.7% vs. 26.7%; p = 0.315). However, among the 12 patients with retinopathy who had available aPL results, occlusive retinopathy occurred in 3/5 (60.0%) aPL-positive patients compared with 0/7 (0%) aPL-negative patients (Fisher’s exact test, p = 0.045). OCT and FFA performed in eight patients demonstrated macular edema and bilateral retinal capillary non-perfusion in all cases. Conclusions: Lupus retinopathy affected approximately one in ten patients with SLE in this Bangladeshi cohort and was strongly associated with severe systemic disease. Although aPL positivity was not associated with retinopathy, it was associated with the occlusive phenotype in an exploratory analysis. These findings warrant confirmation in larger prospective studies with systematic aPL testing.
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BibTeX
@article{shafin2026lupus,
title = {{Lupus Retinopathy in Systemic Lupus Erythematosus: Prevalence, Phenotypic Spectrum, and Associations with Severe Disease Activity and Antiphospholipid Antibody Status}},
author = {Shifat Shafin and Md Nazrul Islam and Mohammad Abul Kalam Azad and Abul Khair Ahmedullah and Manik Kumar Talukder and Tariq Reza Ali and Khondokar Mahbub-Uz-Zaman and Nira Ferdous},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218697},
url = {https://www.mdpi.com/2077-0383/15/21/8697},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lupus Retinopathy in Systemic Lupus Erythematosus: Prevalence, Phenotypic Spectrum, and Associations with Severe Disease Activity and Antiphospholipid Antibody Status
AU - Shifat Shafin
AU - Md Nazrul Islam
AU - Mohammad Abul Kalam Azad
AU - Abul Khair Ahmedullah
AU - Manik Kumar Talukder
AU - Tariq Reza Ali
AU - Khondokar Mahbub-Uz-Zaman
AU - Nira Ferdous
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218697
UR - https://www.mdpi.com/2077-0383/15/21/8697
AB - Background/Objectives: Lupus retinopathy is an uncommon but clinically important manifestation of systemic lupus erythematosus (SLE) that may reflect systemic vascular injury and increased activity. However, data from South Asian populations are limited. To determine the prevalence, clinical spectrum, and factors associated with lupus retinopathy in patients with SLE, with particular emphasis on disease activity and antiphospholipid antibody (aPL) status. Methods: This hospital-based cross-sectional study included adults with SLE who met the 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology classification criteria and were consecutively recruited at a tertiary referral center in Bangladesh. All participants underwent comprehensive ophthalmological examinations, including dilated fundus examinations and fundus photography. Optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) were conducted as needed in the study. We evaluated disease activity using the SLE Disease Activity Index 2000 (SLEDAI-2K). We used logistic regression to examine the relationship between lupus retinopathy and other factors. We also analyzed the association between aPL status and retinopathy phenotype using Fisher’s exact test. Results: Among 159 patients with SLE, 18 (11.3%) had ocular involvement and 16 (10.1%) had lupus retinopathy. Of the 16 patients with retinopathy, 11 (68.8%) had mild, 2 (12.5%) had moderate, and 3 (18.8%) had severe disease; 3 (18.8%) had occlusive and 13 (81.3%) had non-occlusive; retinonocclusive systemic disease activity was independently associated with lupus retinopathy (adjusted odds ratio [aOR], 7.20; 95% confidence interval [CI], 1.78–29.11; p = 0.006). Renal involvement was not independently associated with retinopathy (aOR, 2.31; 95% CI, 0.56–9.58; p = 0.247). Among patients with available aPL results, aPL positivity was not significantly associated with lupus retinopathy (41.7% vs. 26.7%; p = 0.315). However, among the 12 patients with retinopathy who had available aPL results, occlusive retinopathy occurred in 3/5 (60.0%) aPL-positive patients compared with 0/7 (0%) aPL-negative patients (Fisher’s exact test, p = 0.045). OCT and FFA performed in eight patients demonstrated macular edema and bilateral retinal capillary non-perfusion in all cases. Conclusions: Lupus retinopathy affected approximately one in ten patients with SLE in this Bangladeshi cohort and was strongly associated with severe systemic disease. Although aPL positivity was not associated with retinopathy, it was associated with the occlusive phenotype in an exploratory analysis. These findings warrant confirmation in larger prospective studies with systematic aPL testing.
SN - 2077-0383
ER -