Scleritis and development of immune-mediated disease: A retrospective chart review.

OBJECTIVE: Scleritis may be idiopathic or caused by trauma, infections, or an immune-mediated condition. Our study aimed to understand the relationship between scleritis and immune-mediated disease, including presenting characteristics, serologies, and treatment course. Understanding these associations may allow clinicians to risk-stratify patients and predict their clinical and treatment course.

METHODS: We conducted a retrospective chart review of 341 scleritis patients seen at a tertiary care center between January 1, 2005, and December 31, 2020. Demographics, scleritis characteristics, treatment response, recurrence, and serologic data were compared among patients with idiopathic and immune-mediated disease-associated scleritis.

RESULTS: Among scleritis patients seen, 145 patients (43%) had an associated immune-mediated disease, most commonly rheumatoid arthritis (39%), vasculitis (21%), or inflammatory bowel disease (14%). In most cases, the immune-mediated disease diagnosis predated the scleritis presentation (65%), though vasculitis cases were more likely to develop during or after scleritis episodes. There were no significant differences in demographics or treatment failures among scleritis patients with and without associated immune-mediated conditions. Patients with immune-mediated diseases were more likely to have a recurrence of scleritis (62% vs 49%, p=0.02).

CONCLUSION: At our ophthalmology center, 43% of patients with scleritis had an associated immunemediated disease, and most patients with immune-mediated disease were symptomatic from this disease prior to scleritis presentation. Rheumatoid arthritis was the most commonly associated condition and typically predated the scleritis, while vasculitis was more likely diagnosed during or after the scleritis episode. Scleritis among immune-mediated disease patients is more likely to recur compared to scleritis that is idiopathic.