PPT INGGRIS 3-2

8/12/2019 PPT INGGRIS 3-2

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I Made Setiadji / 030.09.114

SYSTEMIC LUPUS ERYTHEMATOSUSAND PSORIATIC EYE-MANIFESTATIONS



Introduction

SLE and Psoriatic eye findings may

include

Conjunctivitis

Dry eye

Episcleritis

Uveitis

Lambert and Wright - 1976

Eye finding in Psoriasis

31.2% of 112 patients with psoriatic arthritis

Conjunctivitis is

the most common

(19.6%)



Immune Disease : Overview

Psoriasis

SLE

TH1-mediated

Long life disease

Can’t be cured

Symptomatic Immunomodulator (CType III hypersensitivity

(Immunocomplex-mediated)

As well as the eye manifestations

Etiology : Unknown

Genetical?

Late awareness : life threatening

Etiology : Unknown

Genetical?

Excessive skin growth scaly

Aestethic, no life threatening



Eye : Anatomy



Psoriasis

Epidemiology

Affect approximately 1%-3% of the U.S.

population, roughly 7.5 million to 8.5 million About 125 million people worldwide

Autoimune disease

Appears on the skin

Appearance in other

organs

occurs when the

immune systemmistakes the skin cells

as a pathogen, and

sends out faulty

signals that speed up

the growth cycle of

skin cells.



Psoriasis Symptoms

Type CharacteristicsPlaque psoriasisGuttate psoriasisErythrodermic

psoriasis

PustularpsoriasisNail psoriasis

Palmar/PlantarpsoriasisPsoriatic arthritisScalp psoriasis

Dry scaling patches (AKA common psoriasis) 75%Drop-like dots, occurs after strep or viral infection 12%Exfoliation of fine scales (total body “dandruff”),

widespread, often accompanied by severe itching andpain 7%Pus-like blisters, noninfectious, fluid contains white bloodcells 2%Seen on toenails and fingernails, starts as numerous pits,at times progresses to yellowing, crumbly, and thickened

nail; nails may sloughErythema, thickening and peeling of the skin, blistering isoften present. Can lead to disability.Inflammation, swelling, and joint destructionPlaque-type lesion



Psoriasis

Injury

Sunlight

Streptococcalinfections

HIV

Drugs

Lithium: Drug that

may be used to treat

depression

Beta-blockers: Drugs

that may be used to

treat high blood

pressure

Antimalarials: Drugs

used to treat malaria

NSAIDs: Drugs, suchas ibuprofen (Motrin

and Advil) or

naproxen (Aleve),

used to reduce

inflammation

Emotional stress

Smoking

Alcohol

Hormone changes

Certain factors may trigger psoriasis:



Psoriasis Immunopathogenesis

Th1

Th17

IL-1

TNF-α

interferon-γ

Interferon-α Dendritic CellsIL-12

IL-23

Key inflammatory

Systemic effects

Nuclear Factor-Kappaβ (NF-K β)

Mitogen Activated Protein Kinase (MAPK)

Eye Manifestations



SLE : Symptoms

Chest pain when taking a deep

breath

Fatigue

Fever with no other cause General discomfort, uneasiness, or

ill feeling (malaise)

Hair loss

Mouth sores Sensitivity to sunlight

Skin rash -- a "butterfly" rash over

the cheeks and bridge of the nose.

Swollen lymph nodes



SLE : Epidemiology

Averages 5.1 per 100,000 population/years in US

According to a 2008 report from the National Arthritis Data Working Group, approximately250,000 Americans have SLE.

Varies by race and ethnicity, with higher ratesreported among black and Hispanic people.

The incidence of SLE in black women isapproximately 4 times higher than in white

women. SLE is also more frequent in Asianwomen than in white women.[14]

Women > Men

Black > Asian > White



SLE : Immunopathogenesis

Caused by circulating immune complexes: type

3 hypersensitivity.

The main antigen in the immune complexes is

double stranded DNA and the antibodies are

IgG anti-DNA.

Ocular disease

Immune complex deposition Vasculitis, thrombosis

identified in blood vessels of

the conjunctiva, retina, choroid,sclera, ciliary body

Anti Phospolipid Antibodies

Anti Neuronal AntibodiesSjorgen’s Syndrome



Psoriatic Eye-Manifestation

Anterior Uveitis

Conjunctivitis

Redness in the eye

Sensitivity to light

Blurred vision

"floaters" in the field-of-vision

PAIN in the eye

Itching is the most typical symptom more than 7

Eyelid swelling

Tearing

Photophobia

Watery discharge

Foreign body sensation



Psoriatic Eye-Manifestation

Episcleritis

Dry Eye

Inflammatory condition affecting the

episcleral tissue that lies between the

conjunctiva and the sclera.

Redness

Eye painEye tenderness


Tearing

Burning

StingingItching

Pain


Redness

Blurry vision

Foreign body sensation

Scleritis: conjunctiva is fine,

so the blood vessels WONT

MOVE

Conjunctivitis: when you

push on the conjunctiva, the

blood vessels move



SLE Eye Manifestation

Caused of red eye in SLE

Caused of loss of vision in SLE

Common Dry Eye (Kerato-Conjunctivitis

Sicca)

Less Common Episcleritis

ScleritisConjunctivitis (Non-infective)

Rare Keratitis

Anterior Uveitis

Anterior segment Severe Kerato-Conjunctivitis Sicca

Lens Cataract

Vitreous Haemorrhage

Retina Severe Vaso-Occlusive Retinopathy

Choroid Lupus Choroidopathy

Neuro-opthalmic Optic Neuritis



Conclusion

Both of SLE and Psoriasis are autoimmunedisease

The difference in pathogenesis and the

occurrence in eye manifestation. Significant ocular pain or reduction of vision are

serious symptoms requiring urgent assessment byan ophthalmologist.

The serious ocular manifestations of SLE (such asscleritis and lupus retinopathy) generally requiresystemic immunosuppression.

More research on the relationship between eyemanifestation and psoriasis or SLE are needed.



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PPT INGGRIS 3-2