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Brief Report |

Association of Systemic Lupus Erythematosus With Uveitis

Kevin Gallagher, BMBCh, FRCOphth1,2; Ananth Viswanathan, FRCOphth1,3,4; Narciss Okhravi, FRCOphth, PhD1,2,3,4
[+] Author Affiliations
1Moorfields Eye Hospital National Health Society Foundation Trust, London, England
2Department of Undergraduate Education, Moorfields Eye Hospital National Health Society Foundation Trust, London, England
3National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital National Health Society Foundation Trust, London, England
4University College London Institute of Ophthalmology, London, England
JAMA Ophthalmol. 2015;133(10):1190-1193. doi:10.1001/jamaophthalmol.2015.2249.
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Importance  Systemic lupus erythematosus (SLE) can be associated with uveitis. The reported prevalence of SLE in patients with uveitis varies from 0.1% to 4.8%. Accordingly, the positive predictive value of antinuclear antibody testing in diagnosing SLE in a patient with uveitis varies enormously. An accurate estimate of SLE prevalence in uveitis is needed to establish the value of routine antinuclear antibody testing in patients with uveitis.

Observations  A literature review using the Medline database was performed to find studies reporting data on uveitis etiology from January 1, 1984, to March 20, 2015. Studies were included where there were sufficient data to draw conclusions on the prevalence of SLE as an etiological factor in uveitis. Data for 53 315 patients were reviewed and 63 studies from 30 countries were included. The prevalence of SLE as a cause of uveitis was estimated to be 0.47% (95% CI, 0.41%-0.53%). The positive predictive value of routine antinuclear antibody testing was 2.9% (95% CI, 2.65%-3.19%).

Conclusions and Relevance  Systemic lupus erythematosus is a rare cause of uveitis. Routine antinuclear antibody testing has a low positive predictive value for SLE. These data suggest such testing should be reserved for patients where there is a higher pretest probability of SLE.

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Figure 1.
Bayesian Analysis of Routine Antinuclear Antibody Testing in Patients With Uveitis
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Figure 2.
Icon Array Showing Results of Antinuclear Antibody Testing in 1000 Patients With Uveitis

Prevalence was 0.47%, sensitivity was 95%, and specificity was 85%. There were 34 false-positive test results for every true-positive test result.

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