Alterações oculares em crianças com lúpus eritematoso sistêmico juvenil em uso de hidroxicloroquina

Abstract

INTRODUCTION: Juvenile systemic lupus erythematosus (JSLE) is characterizedbysystemic symptoms and multiorgan involvement. The ophthalmological manifestationsofJSLE involve multiple ocular structures. The hydroxychloroquine (HCQ)-inducedmaculopathy and dry eye disease (DED) are complications that may present signsorsymptoms such as discomfort, visual disturbances, damage to the ocular surface andmacula,leading to blindness. OBJECTIVES: This cross-sectional study aims to describe theocularfindings in patients with juvenile systemic lupus erythematosus (JSLE) followed at atertiarycare referral center in Brazil, in addition to evaluating associations betweenclinical,laboratory, and ophthalmological findings, with a focus on retinal toxicity secondarytotheuse of hydroxychloroquine (HCQ) and dry eye disease (DED). METHODS: This wasadescriptive, retrospective, cross-sectional study involving children and adolescents classifiedas JSLE according to the SLICC (Systemic Lupus Collaborating Clinics) criteria. Informationwas collected from medical records using a standardized data collection instrument. Acomplete ophthalmological examination, including tear evaluation, optical coherencetomography (SD-OCT), and near-infrared imaging (NIR), was performed. The resultsweredescribed using mean and standard deviation or median and interquartile range (accordingtothe data distribution assessed by normality tests) for quantitative/continuous variablesandabsolute frequency and percentage for qualitative/categorical variables. Binarylogisticregression was used to assess the associations between clinical, laboratory, andophthalmological findings with NIR and DED. RESULTS: : Forty-six patients were included,majority were female (39 - 84.8%) and African-Latin- American (43 - 93.5%), withamedianage at diagnosis of 10 years (6-18 years, IQR 3), and median disease duration of 38.5months(2-112, IQR 32). The median SLEDAI disease activity score was 2 (0-16, IQR5). Themediancumulative HCQ dose was 250 g (6g - 709.20g; SD 184.13), used for a mediantimeof2years (0-9, IQR 4). The most frequent clinical manifestations were arthritis, nephritis, andacute/subacute cutaneous lupus. ANA was reactive in 44 patients (95.7%), anti-dsDNAin22(47.8%), 24 (52.2%) anti-SSA and/or anti-SSB positive. No changes were found inSD-OCTrelated to the use of HCQ. Near InfraRed showed hyperreflectivity in 65.63%of thestudiedpopulation. There was no statistically significant difference between patients withalteredNear Infrared and those without changes regarding the cumulative dose and durationof HCQuse, as well as with clinical and laboratory findings and treatment. Only a significantassociation was found between DED and the use of mycophenolate mofetil (p =0.041). Nocorrelation was observed between DED and clinical, laboratory findings, or other medications.CONCLUSION: The prevalence of asymptomatic DED is significant in the studypopulation,suggesting the importance of active investigation of dry eye disease in children withJSLE.The study population did not present retinal SD-OCT changes, and those describedintheNear Infrared may suggest that this exam should be explored in the evaluationof retinaltoxicity due to chronic HCQ use.