Date post: | 03-Jun-2018 |
Category: |
Documents |
Upload: | herjuno-darpito |
View: | 230 times |
Download: | 0 times |
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 1/17
I Made Setiadji / 030.09.114
SYSTEMIC LUPUS ERYTHEMATOSUSAND PSORIATIC EYE-MANIFESTATIONS
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 2/17
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%)
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 3/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 4/17
Eye : Anatomy
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 5/17
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.
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 6/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 7/17
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:
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 8/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 9/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 10/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 11/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 12/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 13/17
Psoriatic Eye-Manifestation
Episcleritis
Dry Eye
Inflammatory condition affecting the
episcleral tissue that lies between the
conjunctiva and the sclera.
Redness
Eye painEye tenderness
Sensitivity to light
Tearing
Burning
StingingItching
Pain
Sensitivity to light
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 14/17
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
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 15/17
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.
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 16/17
References Vrabec F. Histologic description of a case of psoriasis with conjunctival, corneal and cutaneous localization. Ophthalmologica. 1952;124(2):105-8.
Sandvig K, Westerberg P. Ocular findings in psoriatics. Acta Ophthalmol (Copenh). 1955;33(4):463-7.
Knox DL. Psoriasis and intraocular inflammation. Trans Am, Ophthalmol Soc. 1979;77:210-24.
Kammer GM, Soter NA, Gibson DJ, Schur PH. Psoriatic arthritis: a clinical, immunologic and HLA study of 100 patients. Semin Arthritis Rheum.
1979;9(2):75-97.
Lambert JR, Wright V. Eye inflammation in psoriatic arthritis. Ann Rheum Dis, 1976;35(4):354-6.
Twilt M, Swart van den Berg JC, van Meurs R, ten Cate R, Van Suijlekom-Smit LW. Persisting uveitis antedating psoriasis in two boys. Eur J Pediatr.
2003;162(9):607-9.
Hantzchel H, Otto W, Romhild N, et al. Characteristics of the early phase of ankylosing spondylitis. Z Gesamte Inn Med. 1981;36(6):189-92. Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol.
1994;21(10):1883-7.
Bloch-Michel E, Nussenblatt RB. International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J
Ophthalmol. 1987;103(2):234-5.
Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop.
Am J Ophthalmol. 2005;140(3):509-16.
Maini R, O’Sullivan J, Reddy A, Watson S, Edelsten C. The risk of complications of uveitis in a district hospital cohort. Br J Ophthalmol. 2004;88(4):512-7.
Agarwal RK, Caspi RR. Rodent models of experimental autoimmune uveitis. Methods Mol Med. 2004;1102:395-419.
Guly CM, Forrester JV. Investigation and management of uveitis. BMJ. 2010;341:c4976.
Paiva ES, Macaluso DC, Edwards A, Rosenbaum JT. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis. 2000;59(1):67-70.
Durrani K, Foster CS. Psoriatic uveitis: a distinct clinical entity? Am J Ophthalmol. 2005;139(1):106-11.
Zengin N, Tol H, Balevi S, Gunduz K, Okudan S, Endogru H. Tear film and meibomian gland functions in psoriasis. Acta Ophthalmol Scand.
1996;74(4):358-60.
Erbagci I, Erbagci Z, Gungor K, Bekir N. Ocular anterior segment pathologies and tear film changes in patients with psoriasis vulgaris. Acta Med
Okayama. 2003;57(6):299-303.
Griffiths CE, Strober BE, van de Kerkhof P, et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med. 362(2):118-
28.
8/12/2019 PPT INGGRIS 3-2
http://slidepdf.com/reader/full/ppt-inggris-3-2 17/17
Thank You