Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

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

Author(s): 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 and Marta Fabiane Gouvêa Barioni

Volume 19, Issue 3, 2023

Published on: 09 March, 2023

Page: [367 - 372] Pages: 6

DOI: 10.2174/1573397119666230222093007

Price: $65

conference banner
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
Wayfinder Image
World Osteoporosis Day
© 2024 Bentham Science Publishers | Privacy Policy