Universidad del Quindío, Cra 15 # Calle 12 Norte, Armenia, Quindío, Colombia.
Clin Rheumatol. 2010 May;29(5):559-61. doi: 10.1007/s10067-009-1368-8. Epub 2010 Feb 14.
Ocular features may occur in longstanding rheumatoid arthritis. Among them, scleritis represents the most frequent manifestation of ophthalmologic rheumatoid disease. There are three types of anterior scleritis: diffuse, nodular, and necrotizing with and without inflammation (scleromalacia perforans). Nodular scleritis is the second cause of anterior scleritis representing 20% of all types of scleritis. The conventional treatment of nodular scleritis consists in topical steroids and DMARDS. In severe cases, the therapy with immunosuppressive agents to avoid complications is necessary. We describe a 46-year-old woman presented right nodular scleritis with rheumatoid arthritis. She was treated initially with topical steroids and DMARDs but was unable to received systemic steroids due to left open angle glaucoma in the opposite eye. After an ocular exacerbation, we initiated adalimumab with complete resolution of nodular scleritis. This is the first report of adalimumab in the treatment of nodular scleritis. Adalimumab could be a good alternative in patients with severe nodular scleritis who fail to have conventional treatment with DMARDs and unable to receive systemic steroids.
眼部表现可能出现在长期存在的类风湿关节炎中。其中，巩膜炎是眼科类风湿疾病最常见的表现。前巩膜炎有三种类型：弥漫性、结节性和坏死性，伴有或不伴有炎症（穿孔性巩膜软化症）。结节性巩膜炎是前巩膜炎的第二大原因，占所有巩膜炎类型的 20%。结节性巩膜炎的常规治疗包括局部皮质类固醇和 DMARDs。在严重的情况下，需要使用免疫抑制剂进行治疗以避免并发症。我们描述了一位 46 岁女性，患有右侧结节性巩膜炎和类风湿关节炎。她最初接受了局部皮质类固醇和 DMARDs 治疗，但由于对侧眼存在开角型青光眼，无法接受全身皮质类固醇治疗。在眼部恶化后，我们开始使用阿达木单抗治疗，结节性巩膜炎完全缓解。这是阿达木单抗治疗结节性巩膜炎的首例报告。对于那些未能接受 DMARDs 常规治疗且不能接受全身皮质类固醇治疗的严重结节性巩膜炎患者，阿达木单抗可能是一种很好的替代治疗方法。
