title: Retinal nerve fiber layer thickness and neuropsychiatric manifestations in systemic lupus erythematosus.
abstract: Background Cognitive impairment is frequent in systemic lupus erythematosus. Atrophy of the corpus callosum and hippocampus have been reported in patients with systemic lupus erythematosus, and diffusion tensor imaging studies have shown impaired white matter integrity, suggesting that white matter damage in systemic lupus erythematosus may underlie the cognitive impairment as well as other neuropsychiatric systemic lupus erythematosus manifestations. Retinal nerve fiber layer thickness, as assessed by optical coherence tomography, has been suggested as a biomarker for white matter damage in neurologic disorders such as multiple sclerosis, Alzheimer's disease and Parkinson's disease. Retinal nerve fiber layer thinning may occur early, even in patients with mild clinical symptoms. Aim The objective of this study was to assess the association of retinal nerve fiber layer thickness, as a biomarker of white matter damage in systemic lupus erythematosus patients, with neuropsychiatric systemic lupus erythematosus manifestations, including cognitive impairment. Methods Twenty-one consecutive patients with systemic lupus erythematosus underwent neuropsychological testing using a validated computerized battery of tests as well as the Rey-Auditory verbal learning test. All 21 patients, as well as 11 healthy, age matched controls, underwent optical coherence tomography testing to assess retinal nerve fiber layer thickness. Correlations between retinal nerve fiber layer thickness and results in eight cognitive domains assessed by the computerized battery of tests as well as the Rey-Auditory verbal learning test were assessed in patients with systemic lupus erythematosus, with and without neuropsychiatric systemic lupus erythematosus, and compared to retinal nerve fiber layer thickness in healthy controls. Results No statistically significant correlation was found between retinal nerve fiber layer thickness in patients with systemic lupus erythematosus as compared to healthy controls. When evaluating by subgroups, no correlation was found between patients with or without neuropsychiatric systemic lupus erythematosus or cognitive impairment and retinal nerve fiber layer thickness. Conclusion Retinal nerve fiber layer thickness of systemic lupus erythematosus patients was not found to be statistically different compared to controls. Within systemic lupus erythematosus patients there was no correlation between retinal nerve fiber layer thickness and cognitive impairment or other neuropsychiatric systemic lupus erythematosus manifestations.
authors.affiliation: 1 Division of Ophthalmology, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Shulman
authors.affiliation: 2 Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Shorer
authors.affiliation: 2 Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Wollman
authors.affiliation: 1 Division of Ophthalmology, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Dotan
authors.affiliation: 2 Department of Rheumatology, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Paran
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology*; D041623:Tomography, Optical Coherence
keywords: Neuropsychiatric lupus; antiphospholipid syndrome; systemic lupus erythematosus