Combined Ophthalmology and Rheumatology Evaluation in Systemic Autoimmune Diseases with Ocular Involvement: A Third Level Reference Center in Mexico

Figures & data

Table 1. Population characteristics according to most frequent rheumatological diseases (n = 228).

	Spondyloarthritis (n = 80)	Rheumatoid arthritis (n = 79)	Primary Sjögren’s syndrome (n = 29)	Granulomatosis with polyangiitis (n = 25)	Systemic lupus erythematosus (n = 15)	Total (n = 228)
Gender — n (%)
Female	37 (46.2)	73 (92.4)	29 (100)	18 (72.0)	13 (86.7)	170(74.6)
Male	43 (53.8)	6 (7.6)	0	7 (28.0)	2 (13.3)	58(25.4)
Age — Years
Median ± SD	44.4 ± 12.6	54.9 ± 12.8	56.3 ± 14.0	47.8 ± 13.9	38 ± 17.5	50 ± 14.3
Age distribution — n (%)
18–44	47 (58.8)	18 (22.8)	4 (13.8)	10 (40.0)	8 (53.3)	87(39.9)
45–64	26 (32.5)	42 (53.2)	17 (58.6)	13 (52.0)	5 (33.3)	93(42.7)
≥ 65	7 (8.8)	19 (24.1)	8 (27.6)	2 (8.0)	2 (13.3)	38(17.4)
Affected eye — n (%)
Right	28 (35.0)	21 (26.6)	2 (6.9)	9 (36.0)	3 (20)	63(27.6)
Left	19 (23.8)	15 (19.0)	4 (13.8)	9 (36.0)	3 (20)	50(21.9)
Bilateral	33 (41.2)	43 (54.4)	23 (79.3)	7 (28.0)	9 (60)	115 (50.5)
Ophthalmologic manifestation — n (%)
Keratoconjunctivitis sicca	0	49 (62)	27 (93.1)	0	5 (33.3)	81(35.5)
Anterior uveitis	70 (87.5)	1 (1.3)	1 (3.4)	0	1 (6.7)	73(32.1)
Scleritis	6 (7.5)	18 (22.8)	0	19 (76)	5 (33.3)	48(21)
Peripheral ulcerative keratitis	0	10 (12.7)	1 (3.4)	6 (24)	1 (6.7)	18(7.9)
Posterior uveitis	0	0	0	0	3 (20)	3(1.3)
Panuveitis	2 (2.5)	0	0	0	0	2(0.9)
Retinal vasculitis	1 (1.2)	1 (1.3)	0	0	0	2(0.9)
Intermediate uveitis	1 (1.2)	0	0	0	0	1(0.4)

Table 2. Population characteristics according to idiopathic diseases (n = 27).

	Scleritis (n = 15)	Anterior uveitis (n = 7)	Intermediate uveitis (n = 2)	Retinal vasculits (n = 2)	PUK(n = 1)	Total (n = 27)
Gender — n (%)
Female	10 (66.7)	5 (71.4)	0	2 (100)	1 (100)	18 (66.7)
Male	5 (33.3)	2 (28.6)	2 (100)	0	0	9 (33.3)
Age — Years
Median ± SD	44 ± 15.5	27 ± 13.5	39.5 ± 17.7	50.4 ± 10.6	23	43 ± 15.5
Age distribution — n (%)
18–44	8 (53.3)	4 (57.1)	1 (50)	1 (50)	1 (100)	15 (55.6)
45–64	5 (33.3)	3 (42.9)	1 (50)	1 (50)	0	10 (37)
≥ 65	2 (13.3)	0	0	0	0	2 (7.4)
Affected eye — n (%)
Right	3 (20)	1 (14.3)	1 (50)	0	1 (100)	6(22.2)
Left	8 (53.3)	2 (28.6)	0	0	0	10(37.1)
Bilateral	4 (26.7)	4 (57.1)	1 (50)	2 (100)	0	11(40.7)

Graph 1. Newly and previously systemic disease diagnoses (n = 249). A total of 94 patients (34.1%) had previously known systemic diagnosis, whereas 157 patients (56.9%) were diagnosed at APEC. Idiopathic causes (n = 27) were excluded from this Graph since no systemic diagnosis was made. *GPA: Granulomatosis with polyangiitis **EGPA: Eosinophilic granulomatosis with polyangiitis.

Table 3. Frequency of systemic diagnoses and idiopathic cases in total studied population (n = 276).

Systemic diseases	n	%
Spondyloarthritis	80	29.0
Rheumatoid arthritis	79	28.6
Primary Sjögren’s syndrome	29	10.5
Granulomatosis with polyangiitis	25	9.1
Systemic lupus erythematosus	15	5.4
Systemic sclerosis	8	2.9
Microscopic polyangiitis	3	1.1
Relapsing polychondritis	3	1.1
Migratory arthritis	2	0.7
Takayasu disease	1	0.4
Dermatomyositis	1	0.4
Eosinophilic granulomatosis with polyangiitis	1	0.4
Antiphospholipid syndrome	1	0.4
Sarcoidosis	1	0.4
Total	249	90.2
Idiopathic manifestations
Scleritis	15	5.4
Anterior uveitis	7	2.5
Intermediate uveitis	2	0.7
Retinal vasculitis	2	0.7
Peripheral ulcerative keratitis	1	0.4
Total	27	9.8

Table 4. Ocular manifestations by order of frequency (n = 276).

Manifestation	n	%
Keratoconjunctivitis sicca	92	33.3
Anterior uveitis	81	29.3
Scleritis	66	23.9
Peripheral ulcerative keratitis	20	7.2
Panuveitis	5	1.8
Retinal vasculitis	5	1.8
Intermediate uveitis	4	1.4
Posterior uveitis	3	1.1

Table 5. Association between systemic diseases and ophthalmological manifestations (n = 249).

	KCS n (%)	Anterior uveitis n (%)	Scleritis n (%)	PUK n (%)	Panuveitis n (%)	Retinal vasculitis n (%)	Posterior uveitis n (%)	Intermediate uveitis n (%)	Total n (%)
SpA	0	70(94.4)	6(11.8)	0	2(40)	1(33.3)	0	1(50)	80(38.7)
RA	49(53.3)	1(1.4)	18(35.3)	10(52.6)	0	1(33.3)	0	0	49(23.7)
pSS	27(29.4)	0	1(2)	1(5.3)	0	0	0	0	27(13)
GPA	0	0	19(37.3)	6(31.5)	0	0	0	0	25(12.1)
SLE	5(5.3)	1(1.4)	5(9.8)	1(5.3)	0	0	3(100)	0	5(2.4)
Systemic sclerosis	7(7.6)	0	0	0	1(20)	0	0	0	8(3.9)
MPA	1(1.1)	0	1(2)	1(5.3)	0	0	0	0	3(1.5)
RP	0	1(1.4)	0	0(0)	2(40)	0	0	0	3(1.5)
Migratory arthritis	2(2.2)	0	0	0	0	0	0	0	2(1)
TA	0	0	0	0	0	1(33.3)	0	0	1(0.5)
DM	1(1.1)	0	0	0	0	0	0	0	1(0.5)
EGPA	0	0	1(2)	0	0	0	0	0	1(0.5)
APS	0	1(1.4)	0	0	0	0	0	0	1(0.5)
Sarcoidosis	0	0	0	0	0	0	0	1(50)	1(0.5)
Total	92 (36.9)	74 (29.7)	51 (20.5)	19 (7.6)	5 (2)	3 (1.2)	3 (1.2)	2 (0.8)	249 (100)

APS: antiphospholipid syndrome, DM: dermatomyositis, EGPA: eosinophilic granulomatosis with polyangiitis. GPA: granulomatosis with polyangiitis, MPA: microscopic polyangiitis, pSS: primary Sjögren’s syndrome, RA: rheumatoid arthritis, RP: relapsing polychondritis, SpA: spondyloarthritis (SpA), SLE: systemic lupus erythematosus,TA: Takayasu arteritis.