Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives
1
Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
2
EA 7516 CHIMERE, Université de Picardie Jules Verne, 80025 Amiens, France
3
Department of Rheumatology, Centre Hospitalier Universitaire Amiens Picardie, 80054 Amiens, France
4
Department of Ophthalmology, Hospital Charles Nicolle, 76000 Rouen, France
5
EA7510, UFR Santé, Rouen University, F-76000 Rouen, France
*
Author to whom correspondence should be addressed.
Academic Editor: Philippe Guilpain
J. Clin. Med. 2021, 10(10), 2118; https://doi.org/10.3390/jcm10102118
Received: 23 April 2021
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Revised: 27 April 2021
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Accepted: 11 May 2021
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Published: 14 May 2021
(This article belongs to the Special Issue Rheumatoid Arthritis: Pathogenesis, Diagnosis and Therapies)
Episcleritis and scleritis are the most common ocular inflammatory manifestation of rheumatoid arthritis. Rheumatoid arthritis (RA) accounts for 8% to 15% of the cases of scleritis, and 2% of patients with RA will develop scleritis. These patients are more likely to present with diffuse or necrotizing forms of scleritis and have an increased risk of ocular complications and refractory scleral inflammation. In this review we provide an overview of diagnosis and management of rheumatoid arthritis-associated episcleritis and scleritis with a focus on recent treatment perspectives. Episcleritis is usually benign and treated with oral non-steroidal anti- inflammatory drugs (NSAIDs) and/or topical steroids. Treatment of scleritis will classically include oral NSAIDs and steroids but may require disease-modifying anti-rheumatic drugs (DMARDs). In refractory cases, treatment with anti TNF biologic agents (infliximab, and adalimumab) is now recommended. Evidence suggests that rituximab may be an effective option, and further studies are needed to investigate the potential role of gevokizumab, tocilizumab, abatacept, tofacitinib, or ACTH gel. A close cooperation is needed between the rheumatology or internal medicine specialist and the ophthalmologist, especially when scleritis may be the first indicator of an underlying rheumatoid vasculitis.
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Keywords:
scleritis; episcleritis; rheumatoid arthritis; ocular inflammation; biologics; treatment; prognosis
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MDPI and ACS Style
Promelle, V.; Goeb, V.; Gueudry, J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. J. Clin. Med. 2021, 10, 2118. https://doi.org/10.3390/jcm10102118
AMA Style
Promelle V, Goeb V, Gueudry J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. Journal of Clinical Medicine. 2021; 10(10):2118. https://doi.org/10.3390/jcm10102118
Chicago/Turabian StylePromelle, Veronique, Vincent Goeb, and Julie Gueudry. 2021. "Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives" Journal of Clinical Medicine 10, no. 10: 2118. https://doi.org/10.3390/jcm10102118
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