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Vergouwen DP, Kolijn PM, de Hoog J, de Boer JH, Los LI, Gijs M, Erckens RJ, de Jong PH, Rothova A, Ten Berge JC, Schreurs MW. Potential Biomarkers for Noninfectious Scleritis Identified by Serum and Tear Fluid Proteomics. OPHTHALMOLOGY SCIENCE 2024; 4:100407. [PMID: 38054106 PMCID: PMC10694766 DOI: 10.1016/j.xops.2023.100407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 12/07/2023]
Abstract
Purpose Scleritis is an extremely painful and potentially blinding inflammation of the sclera with unknown pathogenesis and unpredictable course. To gain insight in its disease process and identify biomarker candidates, we performed extensive proteomics in serum and tear fluid. Design Prospective multicenter cohort study. Participants A total of 121 patients with noninfectious scleritis (of which 39 active cases), 30 healthy controls, and 23 disease controls (uveitis and rheumatoid arthritis) were enrolled in the Netherlands from 2020 to 2022. Methods Serum, tear fluid of both eyes, and clinical data were gathered. The level of 368 inflammatory proteins was measured using proximity extension assays. Results were validated in an independent cohort of 15 patients with scleritis, and using addressable laser bead immunoassay, or enzyme-linked immunoassays. In addition, we studied an extended panel of matrix metalloproteinases in tear fluid of necrotizing scleritis with addressable laser bead immunoassay. Main Outcome Measures Statistically significant differences in the level of inflammatory proteins between patients with scleritis and control groups. Results Proteomics revealed 18 significantly upregulated or downregulated serum proteins in active scleritis cases compared with all control groups in both the discovery cohort and the validation cohort. The most upregulated protein was nuclear migration protein nudC (NudC; P = 0.0032), a protein involved in neurogenesis. The other significant hits included proteins involved in T-cell activation, apoptosis, epithelial barrier maintenance, and angiogenesis. Our tear fluid analysis showed matrix metalloproteinase 9 (MMP9) to be upregulated in the tear fluid of patients with scleral necrosis. Conclusions The results of our proteomics analysis suggest a role for neurogenesis, T-cell activation, disruption of epithelial barrier, and angiogenesis in the pathogenesis of scleritis, and highlight MMP9 and NudC as biomarkers with potential clinical relevance. Funding Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Daphne P.C. Vergouwen
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P. Martijn Kolijn
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joeri de Hoog
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joke H. de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonoor I. Los
- Department of Ophthalmology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marlies Gijs
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Roel J. Erckens
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pascal H.P. de Jong
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Josianne C. Ten Berge
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco W.J. Schreurs
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Corbitt K, Nowatzky J. Inflammatory eye disease for rheumatologists. Curr Opin Rheumatol 2023; 35:201-212. [PMID: 36943695 PMCID: PMC10461883 DOI: 10.1097/bor.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review provides a framework for understanding inflammatory eye disease diagnosis, differential diagnosis, and management for rheumatologists. Uveitis, scleritis, episcleritis, peripheral ulcerative keratitis, and orbital inflammation are all discussed. The goal is to facilitate the development of approaches to inflammatory eye diseases that will help rheumatologists co-manage these patients with eye care providers specializing in ocular inflammation. RECENT FINDINGS In recent years, studies have aimed to advance biologic treatments and define standard-of-care therapy. Inflammatory eye diseases are highly heterogeneous and often rare, which poses significant challenges to their research and the interpretation of existing data. To date, glucocorticoids, mycophenolate, methotrexate, and TNF inhibitors remain the mainstay of treatment options for many of these diseases. SUMMARY Patients with inflammatory eye diseases require multidisciplinary care for best outcomes, frequently including rheumatologists. Understanding the differentials, diagnostics, and treatment are essential to preserving vision in these patients. The diverse nature of the disease processes within this field requires focusing on specific disease phenotypes and endotypes in research and clinical practice.
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Affiliation(s)
- Kelly Corbitt
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
| | - Johannes Nowatzky
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology
- New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Behçet’s Disease Program, NYU Ocular Rheumatology Program
- New York University Grossman School of Medicine, Department of Pathology
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Vergouwen DPC, Ten Berge JC, Boukhrissi S, Rothova A, Schreurs MWJ. Clinical Relevance of Autoantibodies and Inflammatory Parameters in Non-infectious Scleritis. Ocul Immunol Inflamm 2022; 30:1859-1865. [PMID: 34464233 DOI: 10.1080/09273948.2021.1966050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Scleritis is a potentially blinding disorder, with highly unpredictable course and outcome. We analyzed the prevalence and clinical relevance of autoantibodies and inflammatory parameters in non-infectious scleritis. METHODS Retrospective analysis of laboratory findings in all consecutive patients at the department of Ophthalmology of the Erasmus MC with non-infectious scleritis. RESULTS We included 81 patients with non-infectious scleritis. A systemic autoimmune disease was present in 46%. Positive anti-nuclear antibodies were found in 30%, anti-neutrophil cytoplasmic antibodies were positive in 19%, and the presence of rheumatoid factor was shown in 17%. The aforementioned autoantibodies, as well as inflammatory parameters, failed to show prognostic clinical value. In contrast, anti-citrullinated peptide antibodies (ACPA), found in 9% of scleritis patients, were significantly associated with the development of scleral necrosis (P = .01). CONCLUSIONS The presence of ACPA in patients with non-infectious scleritis was associated with the development of scleral necrosis.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - S Boukhrissi
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M W J Schreurs
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Armbrust KR, Kopplin LJ. Characteristics and Outcomes of Patients with Scleritis in the IRIS® Registry (Intelligent Research in Sight) Database. OPHTHALMOLOGY SCIENCE 2022; 2:100178. [PMID: 36245751 PMCID: PMC9559886 DOI: 10.1016/j.xops.2022.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To report patient characteristics and factors associated with poor visual acuity and abnormal intraocular pressure (IOP) in patients with scleritis in the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective cohort study. PARTICIPANTS Patients in the IRIS Registry with at least 3 office visits associated with an International Classification of Diseases scleritis code from 2013 through 2019. METHODS We evaluated demographic and clinical characteristics in scleritis and scleritis subtype cohorts. We conducted Cox proportional hazards and multiple logistic regression analyses to assess associations with poor best-corrected visual acuity (BCVA), vision loss, and IOP abnormalities. MAIN OUTCOME MEASURES Patient characteristics, BCVA of 0.6 logarithm of the minimum angle of resolution (logMAR) or more, BCVA worsened by more than 3 logMAR units 6 months after presentation, IOP of 30 mmHg or more, and IOP of 5 mmHg or less. RESULTS In this cohort of 111 314 patients with scleritis, the mean ± standard deviation age was 58.5 ± 16.6 years, 66% were women, and 30% had bilateral scleritis. Patients with scleromalacia perforans were older and more likely to have bilateral disease. Multiple logistic regression analysis identified factors with increased odds for poor presenting BCVA (older age, male sex, Black race, Hispanic ethnicity, smoking, and scleritis subtypes) and at least 3 lines of vision loss 6 months after initial scleritis diagnosis (older age, smoking, and anterior scleritis). Cox proportional hazards regression modeling of BCVA of 0.6 logMAR or more showed older age (adjusted hazard ratio [aHR] per 10-year unit, 1.11), Black race (aHR, 1.19), Hispanic ethnicity (aHR, 1.22), active smoking (aHR, 1.39), former smoking (aHR, 1.26), and certain scleritis subtypes increase the risk of poor visual acuity development (P < 0.001 for all). Older age, male sex, Black race, Hispanic ethnicity, smoking, and scleritis subtypes increased the odds of IOP abnormality. CONCLUSIONS Older age, Black or Hispanic ancestry, smoking, and specific scleritis subtypes are risk factors for worse visual and IOP outcomes in patients with scleritis in the IRIS Registry. Closer follow-up may be appropriate for older, Black, or Hispanic patients with scleritis; smokers should receive smoking cessation assistance.
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Key Words
- BCVA, best-corrected visual acuity
- CI, confidence interval
- Database
- ICD, International Classification of Diseases
- ICD-10, International Classification of Diseases, Tenth Revision
- ICD-9, International Classification of Diseases, Ninth Revision
- IOP, intraocular pressure
- IRIS Registry
- IRIS, Intelligent Research in Sight
- Intraocular pressure
- OR, odds ratio
- SD, standard deviation
- Scleritis
- Visual acuity
- aHR, adjusted hazard ratio
- logMAR, logarithm of the minimum angle of resolution
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Affiliation(s)
- Karen R. Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Laura J. Kopplin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin—Madison, Madison, Wisconsin
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Sujitha D, Arthi M, Rajan M. Red flag: Ocular clues to systemic disease. Indian J Ophthalmol 2022; 70:2224. [PMID: 35791099 PMCID: PMC9426119 DOI: 10.4103/ijo.ijo_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D Sujitha
- Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - M Arthi
- Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Mohan Rajan
- Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
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Braithwaite T, Adderley NJ, Subramanian A, Galloway J, Kempen JH, Gokhale K, Cope AP, Dick AD, Nirantharakumar K, Denniston AK. 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; 73:1267-1276. [PMID: 33728815 DOI: 10.1002/art.41709] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate 22-year trends in the prevalence and incidence of scleritis, and the associations of scleritis with infectious and immune-mediated inflammatory diseases (I-IMIDs) in the UK. METHODS The retrospective cross-sectional and population cohort study (1997-2018) included 10,939,823 patients (2,946 incident scleritis cases) in The Health Improvement Network, a nationally representative primary care records database. The case-control and matched cohort study (1995-2019) included 3,005 incident scleritis cases and 12,020 control patients matched by age, sex, region, and Townsend deprivation index. Data were analyzed using multivariable Poisson regression, multivariable logistic regression, and Cox proportional hazards multivariable models adjusted for age, sex, Townsend deprivation index, race/ethnicity, smoking status, nation within the UK, and body mass index. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Scleritis incidence rates per 100,000 person-years declined from 4.23 (95% CI 2.16-6.31) to 2.79 (95% CI 2.19-3.39) between 1997 and 2018. The prevalence of scleritis per 100,000 person-years was 93.62 (95% CI 90.17-97.07) in 2018 (61,650 UK patients). Among 2,946 patients with incident scleritis, 1,831 (62.2%) were female, the mean ± SD age was 44.9 ± 17.6 years (range 1-93), and 1,257 (88.8%) were White. Higher risk of incident scleritis was associated with female sex (adjusted IRR 1.53 [95% CI 1.43-1.66], P < 0.001), Black race/ethnicity (adjusted IRR 1.52 [95% CI 1.14-2.01], P = 0.004 compared to White race/ethnicity), or South Asian race/ethnicity (adjusted IRR 1.50 [95% CI 1.19-1.90], P < 0.001 compared to White race/ethnicity), and older age (peak adjusted IRR 4.95 [95% CI 3.99-6.14], P < 0.001 for patients ages 51-60 years versus those ages ≤10 years). Compared to controls, scleritis patients had a 2-fold increased risk of a prior I-IMID diagnosis (17 I-IMIDs, P < 0.001) and significantly increased risk of subsequent diagnosis (13 I-IMIDs). The I-IMIDs most strongly associated with scleritis included granulomatosis with polyangiitis, Behçet's disease, and Sjögren's syndrome. CONCLUSION From 1997 through 2018, the UK incidence of scleritis declined from 4.23 to 2.79/100,000 person-years. Incident scleritis was associated with 19 I-IMIDs, providing data for rational investigation and cross-specialty engagement.
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Affiliation(s)
- Tasanee Braithwaite
- Centre for Rheumatic Diseases and School of Life Course Sciences, King's College London, The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK, and the Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - James Galloway
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - John H Kempen
- Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, and MyungSung Christian Medical Center General Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew P Cope
- Centre for Rheumatic Diseases, King's College London, UK, and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Andrew D Dick
- Institute of Ophthalmology, University College London, London, UK, and University of Bristol, Bristol, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK, and Health Data Research UK, London, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK, and NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, Institute of Ophthalmology, University College London, and Health Data Research UK, London, UK
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7
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Ye Y, Qiu H. Using urban landscape pattern to understand and evaluate infectious disease risk. URBAN FORESTRY & URBAN GREENING 2021; 62:127126. [PMID: 33824634 PMCID: PMC8017915 DOI: 10.1016/j.ufug.2021.127126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 05/24/2023]
Abstract
COVID-19 case numbers in 161 sub-districts of Wuhan were investigated based on landscape epidemiology, and their landscape metrics were calculated based on land use/land cover (LULC). Initially, a mediation model verified a partially mediated population role in the relationship between landscape pattern and infection number. Adjusted incidence rate (AIR) and community safety index (CSI), two indicators for infection risk in sub-districts, were 25.82∼63.56 ‱ and 3.00∼15.87 respectively, and central urban sub-districts were at higher infection risk. Geographically weighted regression (GWR) performed better than OLS regression with AICc differences of 7.951∼181.261. The adjusted R2 in GWR models of class-level index and infection risk were 0.697 to 0.817, while for the landscape-level index they were 0.668 to 0.835. Secondly, 16 key landscape metrics were identified based on GWR, and then a prediction model for infection risk in sub-districts and communities was developed. Using principal component analysis (PCA), development intensity, landscape level, and urban blue-green space were considered to be principal components affecting disease infection risk, explaining 73.1 % of the total variance. Cropland (PLAND and LSI), urban land (NP, LPI, and LSI) and unused land (NP) represent development intensity, greatly affecting infection risk in urban areas. Landscape level CONTAG, DIVISION, SHDI, and SHEI represent mobility and connectivity, having a profound impact on infection risk in both urban and suburban areas. Water (PLAND, NP, LPI, and LSI) and woodland (NP, and LSI) represent urban blue-green spaces, and were particularly important for infection risk in suburban areas. Based on urban landscape pattern, we proposed a framework to understand and evaluate infection risk. These findings provide a basis for risk evaluation and policy-making of urban infectious disease, which is significant for community management and urban planning for infectious disease worldwide.
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Affiliation(s)
- Yang Ye
- Department of Landscape Architecture, College of Horticulture and Forest, Huazhong Agricultural University, No. 1, Shizishan Street, Hongshan District, Wuhan, Hubei Province, 430070, China
- Key Laboratory of Urban Agriculture in Central China, Ministry of Agriculture and Rural Affairs, China
| | - Hongfei Qiu
- Department of Landscape Architecture, College of Horticulture and Forest, Huazhong Agricultural University, No. 1, Shizishan Street, Hongshan District, Wuhan, Hubei Province, 430070, China
- Key Laboratory of Urban Agriculture in Central China, Ministry of Agriculture and Rural Affairs, China
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Promelle V, Goeb V, Gueudry J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. J Clin Med 2021; 10:jcm10102118. [PMID: 34068884 PMCID: PMC8156434 DOI: 10.3390/jcm10102118] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
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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Affiliation(s)
- Veronique Promelle
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
- EA 7516 CHIMERE, Université de Picardie Jules Verne, 80025 Amiens, France;
- Correspondence: ; Tel.: +1-416-813-8942
| | - Vincent Goeb
- EA 7516 CHIMERE, Université de Picardie Jules Verne, 80025 Amiens, France;
- Department of Rheumatology, Centre Hospitalier Universitaire Amiens Picardie, 80054 Amiens, France
| | - Julie Gueudry
- Department of Ophthalmology, Hospital Charles Nicolle, 76000 Rouen, France;
- EA7510, UFR Santé, Rouen University, F-76000 Rouen, France
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Berkenstock MK, Carey AR. Health system wide "big data" analysis of rheumatologic conditions and scleritis. BMC Ophthalmol 2021; 21:14. [PMID: 33407267 PMCID: PMC7788757 DOI: 10.1186/s12886-020-01769-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The development of scleritis in the setting of autoimmune conditions has been well documented. Prior series have assessed the relationship between systemic autoimmune disorders and scleritis only in patients referred for rheumatologic or ocular inflammation. This can lead to a referral bias. We reviewed all charts within the electronic medical record (EMR) of a health system for patients with systemic autoimmune and scleritis diagnoses to determine the prevalence of both and which disorders had the highest relative risk of developing scleritis. METHODS The EMR was searched for scleritis and systemic inflammatory diagnoses in the past medical history and diagnosis tabs, and for associated disease specific laboratory values. The intersection of scleritis and systemic inflammatory conditions was assessed through searching both SNOMED Clinical Terminology and ICD-10 codes for diagnoses. The prevalence of each autoimmune disorder, scleritis prevalence, the percentage of patients with an autoimmune condition having scleritis, the percentage of patients with scleritis having an autoimmune condition; the relative risk (RR) of scleritis patients having a specific autoimmune disorder were calculated. RESULTS A total of 5.9 million charts were searched with autoimmune conditions identified in 148,993 patients. The most common autoimmune conditions overall were HLA-B27-associated diseases (n = 26,680; prevalence 0.45%); rheumatoid arthritis (RA)(N = 19,923; prevalence 0.34%). Conversely, 2702 patients were identified with scleritis (prevalence 0.05%), of which 31.4% had an associated autoimmune condition. Patients with RA represented the highest percentage of patients with an autoimmune condition having scleritis. Granulomatosis with polyangiitis (GPA) represented the highest the percentage of patients with scleritis having an autoimmune condition. Sjogrens was the third most common condition associated with scleritis- making up 4.5% of cases. An association with juvenile idiopathic arthritis (JIA) was seen in 0.3% of patients. CONCLUSIONS While this is the largest retrospective review examining the association between autoimmune disease and scleritis, the findings are similar to prior studies with nearly a third of scleritis patients having an underlying autoimmune diagnosis. Limitations of the study included accurate chart coding; having laboratory results within the searchable EMR. Future research is needed to delineate associations of systemic disease with the anatomic location of scleritis using EMR.
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Affiliation(s)
- Meghan K Berkenstock
- Division of Ocular Immunology, Wilmer Eye Institute, 600 N. Wolfe St., Maumenee Building, 3rd floor, Baltimore, MD, 21287, USA.
| | - Andrew R Carey
- Division of Neuro-Ophthalmology, Wilmer Eye Institute, Baltimore, MD, USA
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Xu TT, Reynolds MM, Hodge DO, Smith WM. Epidemiology and Clinical Characteristics of Episcleritis and Scleritis in Olmsted County, Minnesota. Am J Ophthalmol 2020; 217:317-324. [PMID: 32437669 DOI: 10.1016/j.ajo.2020.04.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the population-based incidence and disease associations of episcleritis and scleritis in a midwestern U.S. POPULATION DESIGN Population-based retrospective cohort study. METHODS All residents of Olmsted County, Minnesota from 2006 to 2015 were identified by using the Rochester Epidemiology Project. A total of 223 episcleritis cases and 77 scleritis cases were identified. The incidence and disease associations of episcleritis and scleritis were assessed, as well as scleritis recurrence rates, treatment, and complications. RESULTS Incidence rates for episcleritis and scleritis were 15.39 and 5.54 per 100,000 per year, respectively. Females accounted for 60.1% of episcleritis and 51.9% of scleritis cases. The mean age at diagnosis was 40.2 years of age for episcleritis and 48.8 years of age for scleritis. In the episcleritis cases, the incidence in females was higher (P = .01). There were no significant differences between sexes for scleritis incidence (P = .75); 23.4% of scleritis patients had an associated systemic disease. Patients with systemic disease showed a trend toward an increased risk of recurrence, but it was not statistically significant. There was a slightly decreased risk of scleritis recurrence with older age at diagnosis (hazard ratio [HR]: 0.73; P = .058; 95% confidence interval [CI]: 0.52-1.01). At last follow-up, most eyes with scleritis (90.4%) had good visual acuity (better than 20/40), and 92.3% had stable or improved visual acuity. CONCLUSIONS The Olmsted County, Minnesota population had a lower incidence of episcleritis and a higher incidence of scleritis than populations in previous studies. The population-based results from the current study may provide information that is more applicable to a primary eye care setting.
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Ingaralingam S, Rauz S, Murray PI, Barry RJ. Effectiveness of pharmacological agents for the treatment of non-infectious scleritis: a systematic review protocol. Syst Rev 2020; 9:54. [PMID: 32164765 PMCID: PMC7068966 DOI: 10.1186/s13643-020-01314-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-infectious scleritis is a potentially sight-threatening condition in which the sclera, the white outer layer of the eye, becomes inflamed. Whilst scleritis can be infective, the majority of cases are due to non-infectious causes, often occurring in association with an underlying systemic autoimmune or auto-inflammatory condition. Thorough systemic work-up is crucial to identify disease aetiology and exclude infection; however, a significant proportion of disease remains idiopathic with the underlying cause unknown. Non-infectious scleritis is normally managed with systemic corticosteroid and immunosuppression, yet there is no widely agreed consensus on the most appropriate therapy, and no national or international guidelines exist for treatment of non-infectious scleritis. METHODS Standard systematic review methodology will be used to identify, select and extract data from comparative studies of pharmacological interventions used to treat patients with non-infectious scleritis. Searches of bibliographic databases (Cochrane Library, MEDLINE, CINAHL and EMBASE) and clinical trial registers will be employed. No restrictions will be placed on language or date of publication. Non-English articles will be translated where necessary. The primary outcome of interest will be disease activity measured by reduction in scleritis grading according to standardised grading systems. Secondary outcomes will include change in best corrected visual acuity, reduction in concurrent dose of systemic corticosteroid, time to treatment failure, adverse events and health-related quality of life. Risk of bias assessment will be conducted appropriate to each study design. Study selection, data extraction and risk of bias assessment will be completed by two reviewers independently. Data will be presented in a table and a narrative synthesis will be undertaken. Meta-analysis will be performed where methodological and clinical homogeneity exists. Subgroup and sensitivity analysis will be undertaken if appropriate. DISCUSSION Many studies have investigated the effectiveness of pharmacological agents used in the management of non-infectious scleritis. A systematic review is needed to collate and analyse this evidence. Findings of this systematic review will help guide ophthalmologists managing patients with non-infectious scleritis and may form the basis for evidence-based recommendations for future clinical practice and encourage standardisation of treatment protocols. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019125198.
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Affiliation(s)
- Sathana Ingaralingam
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK
| | - Robert J Barry
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, B18 7QU, UK. .,Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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