Abstract
Purpose :
We performed a retrospective, observational clinical study to learn about factors that affect resolution and quiescence of inflammation in acute non-infectious scleritis.
Methods :
115 patients with noninfectious scleritis presenting to a tertiary referral center between 2013 and 2018 were identified. Data was collected on demographic factors, comorbidities, and treatment.. The primary outcome measure was time until quiescence. Treatments compared included steroids, Nonsteroidal anti-inflammatory drugs (NSAIDs), and non-glucocorticoid immune modulatory therapy (IMT). The study was approved by the Yale School of Medicine IRB.
Results :
Of 115 patients, 85 had an episode of active scleritis during our observation period. 105 had non-necrotizing anterior scleritis, 4 had necrotizing anterior scleritis, and 6 had posterior scleritis. The mean age was 52±16.8. 70% were female and 30% were male (p<0.001). 37% had a comorbid autoimmune disease, most commonly rheumatoid arthritis and inflammatory bowel disease. There was no significant difference in the prevalence of autoimmune conditions among male and female patients, however males had more comorbidity overall as defined by the Charlson comorbidity index (95% CI 0.17,2.23). Median resolution time [defined as quiescence of symptoms for greater than 3 months] was 59 days (range of 4 to 204 days). Age, gender, autoimmune and overall comorbidity, smoking, and race had no effect on resolution of anterior non-necrotizing scleritis. There was no difference in resolution time among those receiving different combinations of topical and systemic steroids and NSAIDs. Patients requiring systemic medications were more likely to require addition of a subsequent agent than those whose inflammation was controlled with topical medication (OR 4.6, 95 CI [2.3,15.7]). 45 patients received IMT. All 45 received at least one antimetabolite agent, most commonly methotrexate. 21 received at least one biologic agent, most commonly TNF-α inhibitors. Each IMT resulted in quiescence equally, both in patients with and without autoimmune diseases
Conclusions :
No patient factors or treatment differences had a significant impact on length of an episode of scleritis. There were no differences in resolution among IMT agents. Patients started on oral therapy with NSAIDs and prednisone are more likely to require escalation of treatment. This is likely reflective of disease severity or presence of systemic disease.
This is a 2020 ARVO Annual Meeting abstract.