title: Corticosteroid-sparing strategies in the treatment of retinal vasculitis in systemic lupus erythematosus.
abstract: BACKGROUND
  Systemic corticosteroids have been traditionally used in the therapy of retinal vasculitis in patients with systemic lupus erythematosus. The high morbidity associated with long-term corticosteroid therapy has prompted the use of corticosteroid-sparing strategies with cytotoxic agents.
  
  
  METHODS
  This retrospective study summarizes the authors' experience of the last 10 years including 9 systemic lupus erythematosus patients with retinal vasculitis who required treatment for longer than 6 months.
  
  
  RESULTS
  Seven of these patients were treated with cytotoxic agents. Average follow-up was 39 months. Inflammation was controlled clinically and angiographically in all patients using the following therapeutic regimens: systemic corticosteroids and hydroxychloroquine (n = 1 patient); systemic corticosteroids and cytotoxic chemotherapy (n = 6); cytotoxic chemotherapy and hydroxychloroquine (n = 1); and hydroxychloroquine alone (n = 1). Visual acuity was preserved (> 20/30) or improved in all patients. All patients retained excellent control of their systemic disease during their follow-up. Side effects of cytotoxic drugs requiring discontinuation of all chemotherapy were not encountered in this group; Imuran therapy did result in substantial adverse effects necessitating its replacement with other drugs.
  
  
  CONCLUSIONS
  These results suggest a valuable role for corticosteroid-sparing drugs in the therapy of retinal vasculitis associated with systemic lupus erythematosus.
authors.affiliation: Service for Inflammatory Eye Diseases, Shiba Hospital, Tel-Hashomer, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Neumann
authors.forename: C S
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D011379:Prognosis; D012164:Retinal Diseases / Q000188:drug therapy; D012171:Retinal Vessels / Q000187:drug effects*; D012189:Retrospective Studies; D014657:Vasculitis / Q000188:drug therapy* / Q000209:etiology; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; D011241:Prednisone