A Comprehensive Approach to Differentiating Systemic Lupus Erythematosus From Other Autoimmune Diseases Presenting With Optic Neuritis

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with significant morbidity and mortality. Early diagnosis is crucial for effective management. Ocular manifestations, particularly optic neuritis (ON), have emerged as potential early signs of SLE. This systematic literature review analyzes 23 studies, including eight retrospective studies, five cross-sectional studies, two cohort studies, four case reports, one narrative review, and three systematic literature reviews, to investigate the use of ON in diagnosing SLE and differentiating it from other autoimmune diseases, most notably multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). A comprehensive literature search was conducted by combining various keywords and MeSH terms, focusing on autoimmune diseases, ON, MS, NMOSD, and SLE. The final selection of 23 studies reflected a methodologically diverse body of literature, enhancing the review's robustness. SLE-associated ON is rare but distinctive, occurring in 1% of SLE patients and often presenting bilaterally with severe visual impairment and intense pain. Recovery of visual acuity is less common in SLE-associated ON compared to idiopathic ON and multiple sclerosis. Diagnostic challenges arise due to overlapping clinical features with NMOSD and MS. Various studies have highlighted the significance of specific antibody profiles, such as anti-aquaporin-4 IgG, in distinguishing between these conditions. Additionally, neuroimaging findings, including MRI characteristics, play a pivotal role in differentiation. SLE patients may exhibit unique lesion patterns spanning multiple vertebral bodies. Dermatological manifestations, genetic factors, and blood biomarkers, such as semaphorins and complement levels, also offer diagnostic insights. This systematic review underscores the importance of integrating clinical, laboratory, and radiologic imaging data for precise diagnosis and differentiation of SLE, NMOSD, and MS when encountering ON in clinical practice. These findings contribute to the development of concrete diagnostic criteria for SLE using ON as an early symptom, facilitating faster diagnosis and more efficient management of this debilitating autoimmune disease.