From the Guidelines
Punctate inner choroidopathy (PIC) is primarily associated with several rheumatological diseases, including sarcoidosis, systemic lupus erythematosus, granulomatosis with polyangiitis, and inflammatory bowel disease. For patients presenting with PIC, a comprehensive systemic workup should be conducted to identify any underlying rheumatological conditions. This workup should include:
- Complete blood count
- Erythrocyte sedimentation rate
- C-reactive protein
- Antinuclear antibody testing
- Rheumatoid factor
- Anti-neutrophil cytoplasmic antibodies
- Angiotensin-converting enzyme levels
- Chest X-ray or CT scan to evaluate for sarcoidosis, as recommended by recent guidelines 1 Additionally, testing for tuberculosis with QuantiFERON-TB Gold or tuberculin skin test is recommended, along with syphilis serology. Depending on clinical suspicion, further specialized tests may include HLA-B27 typing, sacroiliac joint imaging, and consultation with a rheumatologist, as suggested by recent studies on immunotherapy-related toxicities 1. A thorough evaluation is crucial because identifying and treating the underlying systemic disease can significantly improve ocular outcomes and prevent recurrences of PIC. Early diagnosis and management of associated rheumatological conditions may also prevent progression of both ocular and systemic manifestations, as these inflammatory conditions often share common immunopathological mechanisms involving T-cell mediated responses and cytokine dysregulation.
From the Research
Punctate Inner Choroidopathy and Associated Rheumatological Diseases
- Punctate inner choroidopathy (PIC) is an uncommon, inflammatory, multifocal chorioretinopathy affecting mostly young myopic women 2.
- There is limited information on the association between PIC and rheumatological diseases, but it has been reported that PIC-like reactions can occur in unrelated retinal diseases, including hereditary retinal conditions and acquired etiologies 3.
- Systemic lupus erythematosus (SLE) has been associated with choroidopathy, which can be a sensitive indicator of lupus activity 4.
- The presence of SLE choroidopathy is generally indicative of coexistent nephropathy, CNS vasculitis, and other SLE visceral lesions 4.
Systemic Workup for Patients with Punctate Inner Choroidopathy
- A comprehensive systemic workup is essential to rule out underlying rheumatological diseases, such as SLE 4.
- The workup may include:
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Antinuclear antibody (ANA) test
- Complement levels
- Urinalysis
- Renal function tests
- Imaging studies (e.g., chest X-ray, abdominal ultrasound)
- The goal of the workup is to identify any underlying systemic disease that may be contributing to the development of PIC or PIC-like reactions 3.
- Treatment of the underlying systemic disease can lead to improvement and resolution of the choroidopathy 4.