Division of Rheumatology and Clinical Immunology, College of Medicine at the University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT, 05401, USA.
Division of Ophthalmology, The University of Vermont Medical Center, Burlington, VT, USA.
Curr Rheumatol Rep. 2020 Mar 26;22(4):11. doi: 10.1007/s11926-020-0885-y.
The aim of this review is to provide the information necessary for recognizing scleritis in rheumatology patients, recognize associated systemic diseases in scleritis patients referred to rheumatology, and choose the best conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic therapy, based on the most recent data.
Scleritis is most often associated with systemic conditions, particularly autoimmune conditions. Rheumatologists should be most vigilant about rheumatoid arthritis and ANCA-associated vasculitis. A recent systemic association has been found with IgG4-related disease as well. Most of the therapeutic decisions are based on observational data. Most recently, there is increasing evidence of the role of rituximab for refractory disease. Scleritis is a severe inflammatory ocular condition that leads to complications including vision loss. It can precede a systemic autoimmune disease diagnosis, especially in the case of vasculitis. Prompt recognition and adequate therapy are needed in order to avoid serious ocular complications. There is an unmet need for (1) head-to-heat trials on csDMARDs and biologic drugs for the treatment of idiopathic scleritis and (2) randomized controlled trials on the treatment of refractory cases.
本文旨在为风湿科医生识别风湿病患者的巩膜炎提供必要信息，识别转诊至风湿科的巩膜炎患者相关的系统性疾病，并根据最新数据选择最佳的常规合成改善病情抗风湿药（csDMARDs）或生物疗法。
巩膜炎最常与系统性疾病相关，尤其是自身免疫性疾病。风湿科医生应特别警惕类风湿关节炎和抗中性粒细胞胞浆抗体相关性血管炎。最近还发现与 IgG4 相关疾病存在系统性关联。大多数治疗决策都是基于观察性数据。最近，越来越多的证据表明利妥昔单抗对难治性疾病有效。巩膜炎是一种严重的眼部炎症性疾病，可导致视力丧失等并发症。它可能先于系统性自身免疫性疾病的诊断，尤其是血管炎。为了避免严重的眼部并发症，需要及时识别和充分治疗。目前，（1）治疗特发性巩膜炎的 csDMARDs 和生物药物的头对头试验，以及（2）治疗难治性病例的随机对照试验，均存在未满足的需求。
