June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Scleritis Associated with Relapsing Polychondritis
Author Affiliations & Notes
  • Luis Gonzalez
    Massachusetts Eye Research and Surgery Institution, Cambridge, MA
    Ocular Immunology and Uveitis Foundation, Cambridge, MA
  • Maite Sainz de la Maza
    Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
  • Nicolas Molina-Prat
    Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
  • Daniel Rojas Crutchik
    Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
  • Priyanka Doctor
    Bay View Clinic, Mumbai, India
  • Joseph Tauber
    Tauber Eye Center, Kansas City, MO
  • C. Stephen Foster
    Massachusetts Eye Research and Surgery Institution, Cambridge, MA
    Ocular Immunology and Uveitis Foundation, Cambridge, MA
  • Footnotes
    Commercial Relationships Luis Gonzalez, Ra Pharmaceuticals, Inc (C); Maite Sainz de la Maza, Allergan (C), Alcon, Labs (R), Merck Sharp and Dohme (R); Nicolas Molina-Prat, None; Daniel Rojas Crutchik, None; Priyanka Doctor, None; Joseph Tauber, Allergan (C), Bausch & Lomb (C), Eyegate (C), eleven Bio (C), Biolase (C); C. Stephen Foster, Abbott Medical Optics (C), Abbott Medical Optics (F), Alcon Laboratories, Inc. (C), Alcon Laboratories, Inc. (F), Allergan, Inc. (C), Allergan, Inc. (F), Eyegate Pharmaceuticals, Inc. (I), Eyegate Pharmaceuticals, Inc. (F), IOP Opthalmics (C), Ista Pharmaceuticals (C), Lux Biosciences, Inc. (C), Lux Biosciences, Inc. (F), Novartis Pharmaceuticals Corporation (C), Novartis Pharmaceuticals Corporation (F), XOMA Ltd (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 873. doi:https://doi.org/
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      Luis Gonzalez, Maite Sainz de la Maza, Nicolas Molina-Prat, Daniel Rojas Crutchik, Priyanka Doctor, Joseph Tauber, C. Stephen Foster; Scleritis Associated with Relapsing Polychondritis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):873. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To evaluate clinical features, ocular complications, and successful therapeutic regimens in patients with scleritis associated with relapsing polychondritis (RP).

Methods: Records of 13 scleritis patients with RP were analyzed and compared with those of 111 scleritis patients with other connective tissue diseases.

Results: Scleritis patients with RP were 8 women and 5 men with a mean age of 50 years (range, 22 to 76 years). Ten patients had diffuse scleritis, 1 had necrotizing scleritis, and 2 had necrotizing scleritis and posterior scleritis. Ocular complications included anterior uveitis (5), peripheral keratitis (2), glaucoma (1), optic neuritis (3) and decrease of vision (5, 3 of them with legal blindness, p<0.001). Scleritis was the initial manifestation whose study led to the diagnosis of RP in 8 of the 13 patients (62%). Five patients (38%) had one or more systemic disorders, including systemic vasculitis (3), rheumatoid arthritis (1), systemic lupus erythematosus (1), and ankylosing spondylitis (AS) (2) (p<0.001); these disorders antedated the RP by a mean of 9 years (2-21). Two patients developed scleritis associated with RP while on infliximab (INFLI) due to their AS with uveitis; changing to adalimumab did not solve the problem. All 13 patients had recurrent scleritis. Successful therapeutic regimens included cyclosphosphamide (6), methotrexate (3), azathioprine (2), mycophenolate mofetil (1), and INFLI (1).

Conclusions: Scleritis associated with RP may be a severe disease often associated with ocular complications which may lead to decrease of vision and even blindness. Scleritis may be the initial manifestation whose study leads to the diagnosis of RP. About 38% of patients will have another systemic disorder, the most frequent being systemic vasculitis. Scleritis associated with RP most often will require immunomodulatory therapy, mainly alkylating or antimetabolite agents, or biologic response modifier drugs, mainly anti-TNFα. However, occasionally, scleritis associated with RP may be an adverse event secondary to the use of anti-TNFα.

Keywords: 708 sclera • 462 clinical (human) or epidemiologic studies: outcomes/complications • 557 inflammation  
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