TY - JOUR
T1 - Ocular microvascular damage in autoimmune rheumatic diseases: The pathophysiological role of the immune system
AU - Hysa, Elvis
AU - Cutolo, Carlo Alberto
AU - Gotelli, Emanuele
AU - Paolino, Sabrina
AU - Cimmino, Marco Amedeo
AU - Pacini, Greta
AU - Pizzorni, Carmen
AU - Sulli, Alberto
AU - Smith, Vanessa
AU - Cutolo, Maurizio
N1 - Funding Information:
M. Cutolo1, S. Paolino1, C. Pizzorni1, E. Gotelli1, V Smith3,4,5 and A. Sulli1 are members of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Vanessa Smith3,4,5 is a Senior Clinical Investigator of the Research Foundation ? Flanders (Belgium) (FWO) [1.8.029.20 N]. The FWO was not involved in study design, collection, analysis and interpretation of data, writing of the report, nor in the decision to submit the manuscript for publication. We thank Dr. Sara De Gregorio who was involved in figure definition.Figs. 1 and 2 were created with www.biorender.com.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/5
Y1 - 2021/5
N2 - Pathological eye involvement represents a quite common finding in a broad spectrum of autoimmune rheumatic diseases (ARDs). Ocular signs, often occur as early manifestations in ARDs, ranging from symptoms related to the mild dry eye disease to sight-threatening pathologies, linked to the immune response against retinal and choroidal vessels. Retinovascular damage driven by markedly inflammatory reactivity need a prompt diagnosis and treatment. Immune-complexes formation, complement activation and antibody-mediated endothelial damage seem to play a key role, particularly, in microvascular damage and ocular symptoms, occurring in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS). Conversely, early alterations of retinal and choroidal vessels in the asymptomatic patient, often detectable coincidentally, might be indicators of widespread vascular injury in other connective tissue diseases. Particularly, endothelin-induced hypoperfusion and pathological peri-choroidal extracellular matrix deposition, might be responsible for the micro-architectural alterations and loss of capillaries detected in systemic sclerosis (SSc). Instead, interferon alpha-mediated microvascular rarefaction, combined with endothelial lesions caused by specific autoantibodies and immune-complexes, appear to play a significant role in retinal vasculopathy associated to inflammatory idiopathic myopathies (IIM). The immuno-pathophysiological mechanisms of ocular microcirculatory damage associated with the major ARDs will be discussed under the light of the most recent achievements.
AB - Pathological eye involvement represents a quite common finding in a broad spectrum of autoimmune rheumatic diseases (ARDs). Ocular signs, often occur as early manifestations in ARDs, ranging from symptoms related to the mild dry eye disease to sight-threatening pathologies, linked to the immune response against retinal and choroidal vessels. Retinovascular damage driven by markedly inflammatory reactivity need a prompt diagnosis and treatment. Immune-complexes formation, complement activation and antibody-mediated endothelial damage seem to play a key role, particularly, in microvascular damage and ocular symptoms, occurring in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS). Conversely, early alterations of retinal and choroidal vessels in the asymptomatic patient, often detectable coincidentally, might be indicators of widespread vascular injury in other connective tissue diseases. Particularly, endothelin-induced hypoperfusion and pathological peri-choroidal extracellular matrix deposition, might be responsible for the micro-architectural alterations and loss of capillaries detected in systemic sclerosis (SSc). Instead, interferon alpha-mediated microvascular rarefaction, combined with endothelial lesions caused by specific autoantibodies and immune-complexes, appear to play a significant role in retinal vasculopathy associated to inflammatory idiopathic myopathies (IIM). The immuno-pathophysiological mechanisms of ocular microcirculatory damage associated with the major ARDs will be discussed under the light of the most recent achievements.
KW - Inflammatory idiopathic myopathies
KW - Ocular microcirculation
KW - Rheumatoid arthritis
KW - Sjögren's syndrome
KW - Systemic lupus erythematosus
KW - Systemic sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85103003043&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85103003043&partnerID=8YFLogxK
U2 - 10.1016/j.autrev.2021.102796
DO - 10.1016/j.autrev.2021.102796
M3 - Review article
C2 - 33722750
AN - SCOPUS:85103003043
VL - 20
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
SN - 1568-9972
IS - 5
M1 - 102796
ER -