Clinical features and prognosis of rheumatic disease-associated episcleritis and scleritis

Abstract

Objective To investigate the clinical characteristics and prognosis of rheumatic disease-associated episcleritis and scleritis. Methods The clinical and laboratory features of 20 in-patients with episcleritis or scleritis from September 2005 to July 2016 in Peking University People's Hospital were analyzed retrospectively. The data of 11 rheumatoid arthritis (RA) patients were compared with 33 RA patients without episcleritis or scleritis of similar gender composition and age presented in the same period. T test, Mann-Whitney U test, chi-square test and rank sum test were used for statistical analysis. Results Among the 20 patients, the average age was (58±15) years old. Episcleritis and scleritis each accounted for half. The spectrum of rheumatic diseases included, in the order of disease frequency, RA, systemic lupus erythematosus (SLE), systemic vasculitis, relapsing polychondritis (RP), ankylosing spondylitis (AS) and undifferentiated connective tissue disease (UCTD). RA and SLE patients accounted for 55% and 20% cases respectively. Episcleritis and scleritis occurred significantly earlier in lupus patients than RA patients [(2.1±1.4) year vs (16.3±12.7) year, t'=3.598, P<0.01]. RA patients with episcleritis or scleritis had higher platelet (PLT) count[(330±138)]×109/L vs (234±91)×109/L, t=2.652, P<0.05), higher X-ray scores (P<0.01), more bone erosion [(90%(10/11) vs 52%(17/33), χ2=3.9, P<0.05] and frequent pulmonary interstitial involvement [46%(15/33) vs 9%(1/11), χ2=5.1, P<0.05]. Among 20 patients, 18 patients received systemic glucocorticosteroid. Patients with sclera involvement received a significantly higher dose of corticosteroid than patients without sclera involvement [(17.1±16.8) mg/d vs (2.2±4.2) mg/d, t'=2.907, P<0.01]. Patients with scleritis received a significantly higher dose of cortico- steroid than patients with episcleritis [(31±14) mg/d vs (5±6) mg/d, t=-3.959, P<0.01]. Disease-modifying anti-rheumatic diseases (DMARDs) and immunosuppressive agents prescribe dincluded methotrexate (MTX), leflunomide (LEF), hydroxychloroquine (HCQ), cyclosporine A (CsA) and cyclophosphamide (CTX). One refractory case of scleritis recovered after the administration of TNF inhibitor agent. Steroids and NSAIDs eye-drops were administered as well. Conclusion Episcleritis and scleritis are relatively rare ocular diseases, which are commonly associated with rheumatic diseases. In patients with RA, the occurrence of episcleritis or scleritis may suggest severe diseases and other co-existing extraarticular manifestations. The scleral involvement in RA patients ismore resistant to treatment compared to SLE. Consideration must be given to both rheumatic diseases and ocular disorders when dealing with the treatment strategy. Key words: Scleritis; Autoimmune diseases; Arthritis, rheumatoid; Lupus erythemat-osus, systemic