Background/Purpose: Cataracts are a significant ocular complication in childhood-onset systemic lupus erythematosus (cSLE). This study aimed to assess the prevalence, time to cataract development, and clinical and genetic risk factors associated with cataracts in cSLE.

Methods: We conducted a cohort study of children and adolescents diagnosed and followed for cSLE until age 18 years at a tertiary lupus clinic from 1992 to 2023. Genotyping was performed using a multiethnic array, ancestry was genetically inferred and individual polygenic risk scores (PRS) for cataracts were calculated using PRSice. Demographic and clinical variables, including sex, age at SLE diagnosis, disease duration, SLE manifestations, and high-dose glucocorticoid (GC) exposure (defined as ≥2 mg/kg/day or ≥40 mg/day if >30 kg, for at least 30 days). Cataract was diagnosed by an ophthalmologist or optometrist and recorded as part of the Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). Summary statistics compared demographic and clinical features between patients with and without cataracts. We completed time to cataract development analyses and estimated the association between clinical features and PRSs with cataract risk in logistic regression models (P< 0.05).

Results: Of 482 cSLE patients, 83% were female. The mean age at diagnosis was 13.1±3.1 years, and mean disease duration was 4.5±3.0 years. The cohort was primarily of European (28%) and East Asian (25%) ancestry, followed by South Asian (18%), Admixed American (17%), and African (12%). Lupus nephritis occurred in 42%, and 49% received high-dose GC.Cataracts were documented in 9% of patients after a mean follow-up of 4.2 years. Cataract prevalence was highest among East Asian (30%), Admixed American (26%), and South Asian (23%) patients but was not statistically significant. High dose GC exposure was associated with cataracts in both univariate and multivariable adjusted models (Table 1).Cataracts PRS was not associated with odds of cataracts in the univariate or models adjusted for sex, ethnicity and high-dose GC exposure.

Conclusion: In this multiethnic cSLE cohort, 9% developed cataracts within 4.2 years of follow-up. High-dose GC exposure significantly increased cataract risk. We did not observe a significant association between a cataracts-PRS and the odds of developing cataracts in children and adolescents with cSLE. Future studies will include participants with adult-onset SLE.

Table 1. Association of cataracts PRS and cataracts in univariate and multivariable adjusted models.

Figure 1. Time to first cataract event in cSLE (n=482).

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-clinical-and-genetic-risk-factors-and-time-to-cataract-development-in-childhood-onset-systemic-lupus-erythematosus/