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Scleritis associated with relapsing polychondritis
  1. Maite Sainz-de-la-Maza1,
  2. Nicolas Molina1,
  3. Luis Alonso Gonzalez-Gonzalez2,3,
  4. Priyanka P Doctor4,
  5. Joseph Tauber5,
  6. C Stephen Foster2,3,6
  1. 1Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
  2. 2Massachusetts Eye Research and Surgery Institution (MERSI), Cambridge, MA, USA
  3. 3Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts, USA
  4. 4BayView Clinic, Mumbai, India
  5. 5Tauber Eye Center, Kansas City, Missouri, USA
  6. 6Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr C Stephen Foster, Massachusetts Eye Research and Surgery Institution, 1440 Main Street, Suite 201, Waltham MA 02451, USA; fosters{at}uveitis.org

Abstract

Aims To evaluate ocular disease characteristics and successful therapeutic regimens in patients with scleritis associated with relapsing polychondritis (RP). To compare these features with those seen in patients with scleritis associated with other systemic immune-mediated diseases (SIMD).

Methods Electronic health records of 13 scleritis patients associated with RP were analysed and compared with those of 113 scleritis patients associated with other SIMD seen at two tertiary referral centres.

Results Scleritis in patients with RP was often bilateral (92.3%), diffuse (76.9%), recurrent (84.6%), sometimes with decreased vision (46.2%), anterior uveitis (38.5%), peripheral keratitis (15.4%) and ocular hypertension (30.8%). Patients with scleritis associated with RP more often had bilateral scleritis (p=0.001), necrotising scleritis (23.1%; p=0.02), recurrences (p=0.001) and decreased vision (three of the six with legal blindness; p=0.012), as compared with patients who had scleritis associated with other SIMD. Nine patients (69.2%) had one or more SIMD other than RP, including systemic vasculitis (4) or other autoimmune disease (8); they antedated RP by 9 years (range 2–21 years). Successful therapy included cyclophosphamide (5), methotrexate (3), azathioprine (3), mycophenolate mofetil (2), infliximab (2) and adalimumab (1).

Conclusions Scleritis may be the first manifestation whose study leads to the diagnosis of RP. Scleritis associated with RP is more often bilateral, necrotising, recurrent and associated with decrease of vision than scleritis associated with other SIMD. About 69.2% of patients will have an additional SIMD disorder. Scleritis associated with RP most often will require immunomodulatory therapy. Occasionally, scleritis with RP may appear while using antitumor necrosis factor α agents.

  • Anterior chamber
  • Diagnostic tests/Investigation
  • Immunology
  • Inflammation
  • Sclera and Episclera

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