Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
The Relationship Between Systemic Vasculitis and Retinal Vasculitis.
Rosenbaum1, James T., Ku2, Jennifer, Ali2, Amro, Choi2, Dongseok, Suhler2, Eric B.
Systemic vasculitis is often assumed to be a common cause of retinal vasculitis. We sought to determine the relationship between retinal vasculitis and systemic vasculitis as diagnosed in a tertiary referral clinic for patients with uveitis.
A selected review was performed on 1390 charts of patients attending the uveitis clinic at the Oregon Health & Science University, Casey Eye Institute, between 1985 and 2010. Included in the review were all patients with diagnoses commonly associated with retinal vasculitis and all patients who were diagnosed with a systemic vasculitis. Retinal vasculitis was identified by perivascular exudates, intraretinal hemorrhage, or cotton wool spots as seen on clinical examination or by vascular occlusion or leakage as identified by fluorescein angiogram.
Of the 1390 charts reviewed, 207 or 14.9% had retinal vasculitis as a component of the intraocular inflammation. Thirty-five patients had retinal vasculitis which was primary, i.e. not associated with a systemic disease, and the dominant manifestation of the uveitis. Fourteen of the patients with retinal vasculitis had Behcet's disease. Only 11 of the 1390 patients with uveitis had a systemic vasculitis, 3 with granulomatosis with polyangiitis (formerly Wegener's granulomatosis), 4 with primary central nervous system vasculitis, 2 with Churg-Strauss syndrome, 1 with leukocytoclastic vasculitis, and one with pulmonary vasculitis. Of these 11, four had retinal vasculitis including one secondary to a CMV retinitis. Thus, systemic vasculitis was directly responsible for 1.4% or 3 of 207 cases of retinal vasculitis. In comparison to systemic vasculitides, non-vasculitic systemic diseases such as sarcoidosis (n=13), immune-mediated syndromes confined to the eye such as birdshot retinochoroidopathy (n=9) or pars planitis (n=36), and intraocular infections (n=29) were far more common causes of retinal vasculitis.
Retinal vasculitis is not defined by vessel wall destruction, a hallmark of systemic vasculitis. Retinal vasculitis is a relatively common feature of uveitis, but it is an extremely uncommon manifestation of the classical systemic vasculitides.
To cite this abstract, please use the following information:
Rosenbaum, James T., Ku, Jennifer, Ali, Amro, Choi, Dongseok, Suhler, Eric B.; The Relationship Between Systemic Vasculitis and Retinal Vasculitis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :856