Two ocular manifestations of Rheumatoid Arthritis: episcleritis and scleritis

Authors

Keywords:

ocular manifestations, rheumatoid arthritis, episcleritis, scleritis

Abstract

Rheumatoid arthritis is a systemic inflammatory disorder
that affects the joints, which can have several
extra-articular manifestations, including inflammatory eye
disease. To provide an overview of the diagnosis and
treatment of two ocular manifestations of rheumatoid
arthritis: episcleritis and scleritis, including an update on
treatment prospects. Ocular manifestations, including
episcleritis, scleritis, peripheral ulcerative keratitis, and
dry eye disease, can be found in up to 39% of
rheumatoid arthritis patients. Although there is no
consensus or guidelines, many options issued from
rheumatology practice will be available for the treatment
of refractory scleritis, once the infectious causes have
been ruled out, allowing rapid control of inflammation,
and avoiding both structural damage to the eye and
complications from long-term steroid use.

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Author Biographies

Francisco Xavier Anda Andrade, Universidad Central del Ecuador, Quito

Médico general

Hendri Heriberto Atiencia Matute, Universidad Central del Ecuador. Quito

Médico general

Mercy Lorena Gómez Guamán, Universidad Central del Ecuador. Quito

Médico general

Lincoln Sebastián Sánchez Villacís, Universidad Central del Ecuador. Quito

Médico general

References

Vignesh APP, Srinivasan R. Ocular manifestations of rheumatoid arthritis and their correlation with anti-cyclic citrullinated peptide antibodies. Clin. Ophthalmol [Internet]. 2015 [Acceso: 28/07/2021]; 9:393-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348132/

Itty S, Pulido JS, Bakri SJ, Baratz KH. Matteson EL, Hodge DO. Anti-Cyclic Citrullinated Peptide, Rheumatoid Factor, and Ocular Symptoms Typical of Rheumatoid Arthritis. Trans. Am. Ophthalmol. Soc [Internet]. 2008 [Acceso: 28/07/2021]; 106:75-81. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646447/

Caimmi C, Crowson CS, Smith WM, Matteson EL, Makol A. Clinical Correlates, Outcomes, and Predictors of Inflammatory Ocular Disease Associated with Rheumatoid Arthritis in the Biologic Era. J. Rheumatol [Internet]. 2018 [Acceso: 28/07/2021]; 45(5):595-603. Disponible en: https://www.jrheum.org/content/jrheum/45/5/595.full.pdf

Watson PG, Hayreh SS. Scleritis and episcleritis. Br. J. Ophthalmol [Internet]. 1976 [Acceso: 28/07/2021]; 60:163-191. Disponible en: https://bjo.bmj.com/content/bjophthalmol/60/3/163.full.pdf

Lavric A, Gonzalez-Lopez JJ, Majumder PD, Bansal N, Biswas J, Pavesio C, Agrawal R. Posterior Scleritis: Analysis of Epidemiology, Clinical Factors, and Risk of Recurrence in a Cohort of 114 Patients. Ocul. Immunol. Inflamm [Internet]. 2016 [Acceso: 28/07/2021]; 24: 6-15. Disponible en: https://doi.org/10.3109/09273948.2015.1005240

Canamary AM, Takahashi WY, Sallum JMF. Autoimmune retinopathy: A Review. Int J Retin Vitr [Internet]. 2018 [Acceso: 28/07/2021]; 4(1). Disponible en: https://doi.org/10.1186/s40942-017-0104-9

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). J. Ophthalmol [Internet]. 2019 [Acceso: 28/07/2021]; 63:417-24. Disponible en: https://link.springer.com/article/10.1007/s10384-019-00674-7

Pattern of Scleritis in an Egyptian Cohort. Ocul. Immunol. Inflamm [Internet]. 2019 [Acceso: 28/07/2021]; 27:890-6. Disponible en: https://doi.org/10.1080/09273948.2018.1544372

Yang P, Ye Z, Tang J, Du L, Zhou Q, Qi J, et al. Clinical Features and Complications of Scleritis in Chinese Patients. Ocul. Immunol. Inflamm [Internet]. 2018 [Acceso: 28/07/2021]; 26:387-396. Disponible en: https://doi.org/10.1080/09273948.2016.1241282

Ryu SJ, Kang MH, Seong M, Cho H, Shin YU. Anterior scleritis following intravitreal injections in a patient with rheumatoid arthritis: A case report. Medicine [Internet]. 2017 [Acceso: 28/07/2021]; 96, e8925. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5709030/

Díaz-Valle D, Sánchez RM, Espartero MF, Allen DP. Treatment of refractory anterior diffuse scleritis with infliximab. Arch. Soc. Esp. Oftalmol [Internet]. 2004 [Acceso: 28/07/2021]; 79:405-8. Disponible en: https://doi.org/10.4321/s0365-66912004000800010

Lawuyi LE, Gurbaxani A. Refractory necrotizing scleritis successfully treated with adalimumab. J. Ophthalmic Inflamm. Infect [Internet]. 2016 [Acceso: 28/07/2021]; 6(37). Disponible en: https://link.springer.com/article/10.1186/s12348-016-0107-y

Tlucek PS, Stone DU. Certolizumab Pegol Therapy for Rheumatoid Arthritis-Associated Scleritis. Cornea [Internet]. 2012 [Acceso: 28/07/2021]; 31, 90-1. Disponible en: https://journals.lww.com/corneajrnl/Abstract/2012/01000/Certolizumab_Pegol_Therapy_for_Rheumatoid.18.aspx

Durrani K, Kempen JH, Ying G-S, Kacmaz RO, Artornsombudh P, Rosenbaum JT, et al. Adalimumab for Ocular Inflammation. Ocul. Immunol. Inflamm [Internet]. 2017 [Acceso: 28/07/2021]; 25:405-12. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5033708/

Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert Panel Recommendations for the Use of Anti-Tumor Necrosis Factor Biologic Agents in Patients with Ocular Inflammatory Disorders. Ophthalmology [Internet]. 2014 [Acceso: 28/07/2021]; 21:785-96. Disponible en: https://doi.org/10.1016/j.ophtha.2013.09.048

Fabiani C, Sota J, Sainz-de-la-Maza M, Pelegrín L, Emmi G, Lopalco G, et al. New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy. Mediat. Inflamm [Internet]. 2020[Acceso: 28/07/2021]; 8294560. Disponible en: https://www.hindawi.com/journals/mi/2020/8294560/

Schuler S, Brunner M, Bernauer W. Rituximab and Acute Retinal Necrosis in a Patient with Scleromalacia and Rheumatoid Arthritis. Ocul. Immunol. Inflamm [Internet]. 2016 [Acceso: 28/07/2021]; 24: 96-8. Disponible en: https://www.tandfonline.com/doi/full/10.3109/09273948.2014.999377

Silpa S Oray M, Preble JM, Foster CS. Outcome of tocilizumab treatment in refractory ocular inflammatory diseases. Acta Ophthalmol [Internet]. 2016 [Acceso: 28/07/2021]; 94, e400-e406. Disponible en: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/aos.13015

Paley MA, Karacal H, Rao PK, Margolis TP, Miner JJ. Tofacitinib for Refractory Uveitis and Scleritis. Am. J. Ophthalmol [Internet]. Case Rep. 2019 [Acceso: 28/07/2021]; 13:53-5. Disponible en: https://www.sciencedirect.com/science/article/pii/S2451993618303402

Pyare R, Kaushik V, Majumder PD, Biswas J. Tofacitinib in recalcitrant scleritis: First case report from India. Indian J. Ophthalmol [Internet]. 2020 [Acceso: 28/07/2021]; 68:1988-90. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690527/

Bomback AS, Tumlin JA, Baranski J, Bourdeau JE, Besarab A, Appel A, et al. Treatment of nephrotic syndrome with adrenocorticotropic hormone (ACTH) Gel. Drug Des. Dev. Ther [Internet]. 2011 [Acceso: 28/07/2021]; 5:147-53. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063118/

Sohn EH, Wang R, Read R, Roufas A, Teo L, Moorthy R, et al. Long-Term, Multicenter Evaluation of Subconjunctival Injection of Triamcinolone for Non-Necrotizing, Noninfectious Anterior Scleritis. Ophthalmology [Internet]. 2011 [Acceso: 28/07/2021]; 118:1932-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184362/

Bhatt N, Dalal M, Tucker W, Obiyor D, Nussenblatt R, Sen HN. Subconjunctival Sirolimus in the Treatment of Autoimmune Non-Necrotizing Anterior Scleritis: Results of a Phase I/II Clinical Trial. Am. J. Ophthalmol [Internet]. 2015 [Acceso: 28/07/2021]; 159: 601-6. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4329278/

Turesson C, O'Fallon WM, Crowson CSm Gabriel SE, Matteson EL. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J. Rheumatol [Internet]. 2002 [Acceso: 28/07/2021]; 29:62-7. Disponible en: https://www.jrheum.org/content/jrheum/29/1/62.full.pdf

Kishore S, Maher L, Majithia V. Rheumatoid Vasculitis: A Diminishing Yet Devastating Menace. Curr. Rheumatol [Internet]. Rep. 2017 [Acceso: 28/07/2021]; 19, 39. Disponible en: https://link.springer.com/article/10.1007/s11926-017-0667-3

Kempen JH, Pistilli M, Begum H, Fitzgerald TD, Liesegang TL, Payal A, et al. Remission of Non-Infectious Anterior Scleritis: Incidence and Predictive Factors. Am. J. Ophthalmol [Internet]. 2019 [Acceso: 28/07/2021]; Disponible en https://doi.org/10.1016/j.ajo.2019.03.024

Published

2021-10-04

How to Cite

1.
Anda Andrade FX, Atiencia Matute HH, Gómez Guamán ML, Sánchez Villacís LS. Two ocular manifestations of Rheumatoid Arthritis: episcleritis and scleritis. Rev. cuba. de Reumatol. [Internet]. 2021 Oct. 4 [cited 2025 Mar. 12];24(1):e238. Available from: https://revreumatologia.sld.cu/index.php/reumatologia/article/view/954

Issue

Section

Opinion article