Looking Beyond the Surface: Multimodal Assessment of Subclinical Microvascular Changes in Juvenile SLE Using OCTA and Nailfold Capillaroscopy.

PURPOSE: Juvenile systemic lupus erythematosus (jSLE) is characterized by immune-mediated microvascular injury. Optical coherence tomography angiography (OCTA) and nailfold videocapillaroscopy (NVC) enable noninvasive assessment of microcirculation. This study aimed to evaluate retinal structural and microvascular alterations in jSLE using OCT/OCTA and investigate their association with peripheral microvascular findings evaluated by NVC.

METHODS

The study included 31 patients with jSLE and 43 healthy controls. Retinal structural parameters, vessel density of the superficial (SCP) and deep capillary plexus (DCP), and foveal avascular zone (FAZ) metrics were analyzed. Associations between OCT/OCTA parameters, clinical variables, and capillaroscopic findings were evaluated.

RESULTS

Patients with jSLE had reduced retinal nerve fiber layer (RNFL) thickness (median 91 vs. 99 µm; p = 0.006) and choroidal thickness (427.5 vs. 449 µm; p = 0.002). SCP vessel density was lower across multiple regions (p ≤ 0.01),DCP parameters did not differ (all p > 0.05). RNFL demonstrated moderate discriminative ability for jSLE (AUC = 0.693), with a cut-off of 100.5 µm (sensitivity 78.6%, specificity 44.2%).NVC revealed non-specific abnormalities in 64.5% of patients, with capillary tortuosity in 54.8%. Significant associations persisted between capillary dilatation and ganglion cell layer thickness (r =  -0.705), crossing capillaries and SCP density (r = 0.785), and abnormal capillaries and FAZ parameters (r =  -0.654).No consistent associations were observed between retinal parameters and disease activity.

CONCLUSION

jSLE is associated with subclinical retinal structural and microvascular alterations. The limited overlap between retinal and peripheral microvascular findings suggests that OCT/OCTA and NVC capture complementary aspects of disease-related vascular injury, supporting a multimodal imaging approach.