Necrotizing Scleritis and Rheumatoid Arthritis: A Clinical Case Report
Supported by A Brief Review with Risk of Bias Analysis

Celso      Busnelo Moreno; João   Carlos   Gonçalves Cruz; Idiberto   Jose   Zotarelli-Filho; Maurélio      de Lima Batista Ribeiro Junior; Marcello   Novoa   Colombo Barboza; Guilherme   Novoa   Colombo Barboza; Marta   Fabiane   Gouvêa Barioni

doi:10.2174/1573397119666230222093007

Abstract

Introduction: Necrotizing scleritis (NS) presents 30%-40% as having a systemic autoimmune condition.

Objective: To present a clinical case report and a systematic review of necrotizing scleritis with ocular manifestation as the first sign of rheumatologic disease.

Methods: The present study was elaborated according to the rules of CARE.

Case Report: A female patient, 63 years old, a white, administrative assistant, presented irritation, low visual acuity (LVA) in the left eye (LE), and headache. Biomicroscopy (BIO) in the right eye (RE) was normal, and the LE showed hyperemia and scleral thinning. After 1 month, the patient returns without signs of infectious diseases in the exams, and after a rheumatological evaluation with a diagnosis of rheumatoid arthritis, methotrexate and prednisone are prescribed. After 2 months, she relapsed and started treatment with anti-TNF, with remission after the 4th dose. After 1 year, she evolved with LVA in LE.

Results: A total of 244 articles were found, 104 articles were evaluated and 10 were included in the brief review. The symmetrical Funnel Plot does not suggest a risk of bias.

Conclusion: Both in the present case report and the literary findings, it was evidenced that the ophthalmologic findings may precede the systemic changes of the disease for the early diagnosis of rheumatoid arthritis.

Keywords: Scleritis, necrotizing scleritis, rheumatological diseases, autoimmune diseases, rheumatoid arthritis, biomicroscopy.

« Previous Next »

Graphical Abstract

[1]
Abdel-Aty A, Gupta A, Del Priore L, Kombo N. Management of noninfectious scleritis. Ther Adv Ophthalmol  2022; 14: 25158414211070879.
 [http://dx.doi.org/10.1177/25158414211070879] [PMID:  35083421]

[2]
Turk MA, Hayworth JL, Nevskaya T, Pope JE. Ocular manifestations in rheumatoid arthritis, connective tissue disease, and vasculitis: A systematic review and metaanalysis. J Rheumatol  2021; 48(1): 25-34.
 [http://dx.doi.org/10.3899/jrheum.190768] [PMID:  32358156]

[3]
Héron E, Bourcier T. Scleritis and episcleritis. J Fr Ophtalmol  2017; 40(8): 681-95.
 [http://dx.doi.org/10.1016/j.jfo.2017.04.007]

[4]
Bielefeld P, Saadoun D, Héron E, et al. Scleritis and systemic diseases: What should know the internist? Rev Med Interne  2018; 39(9): 711-20.
 [http://dx.doi.org/10.1016/j.revmed.2018.02.001]

[5]
Akpek EK, Bunya VY, Saldanha IJ. Sjögren’s syndrome: More than just dry eye. Cornea  2019; 38(5): 658-61.
 [http://dx.doi.org/10.1097/ICO.0000000000001865] [PMID:  30681523]

[6]
Martín-Nares E, Delgado-de la Mora J, Martínez-Benítez B, Hernandez-Molina G. Aortitis in rheumatoid arthritis: Think on overlapping IgG4-related disease. J Clin Rheumatol  2021; 27(8S): S863.
 [http://dx.doi.org/10.1097/RHU.0000000000001770] [PMID:  34294662]

[7]
Dammacco R, Guerriero S, Alessio G, Dammacco F. Natural and iatrogenic ocular manifestations of rheumatoid arthritis: A systematic review. Int Ophthalmol  2022; 42(2): 689-711.
 [http://dx.doi.org/10.1007/s10792-021-02058-8] [PMID:  34802085]

[8]
Sims J. Scleritis: presentations, disease associations and management. Postgrad Med J  2012; 88(1046): 713-8.
 [http://dx.doi.org/10.1136/postgradmedj-2011-130282] [PMID:  22977282]

[9]
Nevares A, Raut R, Libman B, Hajj-Ali R. Noninfectious autoimmune scleritis: Recognition, systemic associations, and therapy. Curr Rheumatol Rep  2020; 22(4): 11.
 [http://dx.doi.org/10.1007/s11926-020-0885-y] [PMID:  32219644]

[10]
Sota J, Girolamo MM, Frediani B, Tosi GM, Cantarini L, Fabiani C. Biologic therapies and small molecules for the management of non-infectious scleritis: A narrative review. Ophthalmol Ther  2021; 10(4): 777-813.
 [http://dx.doi.org/10.1007/s40123-021-00393-8] [PMID:  34476773]

[11]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ  2021; 372: n71.
 [http://dx.doi.org/10.1136/bmj.n71] [PMID:  33782057]

[12]
Balshem H. Grade guidelines: 3 ratng the quality of evidence. J Clin Epidemiol  2011; 64(4): 401-6.

[13]
Higgins S. Green, Cochrane Handbook for Systematic Reviews of Interventions Version 510. United Kingdom: The Cochrane Collaboration 2011.

[14]
Berkenstock MK, Carey AR. Health system wide “big data” analysis of rheumatologic conditions and scleritis. BMC Ophthalmol  2021; 21(1): 14.
 [http://dx.doi.org/10.1186/s12886-020-01769-3] [PMID:  33407267]

[15]
Yoshida A, Watanabe M, Okubo A, Kawashima H. Clinical characteristics of scleritis patients with emphasized comparison of associated systemic diseases (anti-neutrophil cytoplasmic antibody-associated vasculitis and rheumatoid arthritis). Jpn J Ophthalmol  2019; 63(5): 417-24.
 [http://dx.doi.org/10.1007/s10384-019-00674-7] [PMID:  31183624]

[16]
Suhler EB, Lim LL, Beardsley RM, et al. Rituximab therapy for refractory scleritis: results of a phase I/II dose-ranging, randomized, clinical trial. Ophthalmology  2014; 121(10): 1885-91.
 [http://dx.doi.org/10.1016/j.ophtha.2014.04.044] [PMID:  24953794]

[17]
Zhang Y, Amin S, Lung KI, Seabury S, Rao N, Toy BC. Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis. PLoS One  2020; 15(8): e0237995.
 [http://dx.doi.org/10.1371/journal.pone.0237995] [PMID:  32841267]

[18]
Lorenzana BN, Alejandre AN. Necrotizing Scleritis. N Engl J Med  2020; 383(19): e110.
 [http://dx.doi.org/10.1056/NEJMicm2004836] [PMID:  33211932]

[19]
Jan RL, Ho CH, Wang JJ, Tseng SH, Chang YS. Associations between Sjögren syndrome, sociodemographic factors, comorbid conditions, and scleritis in a Taiwanese population-based study. J Pers Med  2022; 12(1): 105.
 [http://dx.doi.org/10.3390/jpm12010105] [PMID:  35055420]

[20]
Hardy S, Hashemi K, Catanese M, et al. Necrotising scleritis and peripheral ulcerative keratitis associated with rheumatoid arthritis treated with rituximab. Klin Monbl Augenheilkd  2017; 234(4): 567-70.
 [http://dx.doi.org/10.1055/s-0042-121315]

[21]
Sumethkul K, Urailert I, Kitumnuaypong T, Angthararak S, Silpa-archa S. The incidence, risk factor, and time to develop rheumatologic diseases after isolated inflammatory eye diseases: a 12-year cohort study. Clin Rheumatol  2022; 41(4): 1003-12. Epub ahead of print
 [http://dx.doi.org/10.1007/s10067-021-06005-x] [PMID:  35001319]

[22]
Uddin Z, Khan A, Haroon M, Faiq M, Rabbani S, Lashari NA. Spectrum of ocular manifestations of rheumatic autoimmune diseases: A tertiary care experience in Pakistan. J Ayub Med Coll Abbottabad  2021; 33(4): 612-6.
 [PMID:  35124918]

[23]
Braithwaite T, Adderley NJ, Subramanian A, et al. Epidemiology of Scleritis in the United Kingdom From 1997 to 2018: Population‐based analysis of 11 million patients and association between scleritis and infectious and immune‐mediated inflammatory disease. Arthritis Rheumatol  2021; 73(7): 1267-76.
 [http://dx.doi.org/10.1002/art.41709] [PMID:  33728815]

Rights & Permissions Print Cite

Article Metrics

28

2

Journal Information

For Authors

For Editors

For Reviewers

Explore Articles

Open Access

Open Access Articles

For Visitors

DOI https://dx.doi.org/10.2174/1573397119666230222093007	Print ISSN 1573-3971
Publisher Name Bentham Science Publisher	Online ISSN 1875-6360

Current Rheumatology Reviews

Necrotizing Scleritis and Rheumatoid Arthritis: A Clinical Case Report Supported by A Brief Review with Risk of Bias Analysis

Abstract

Graphical Abstract

Related Books

Related Articles