Berkenstock Meghan K, Carey Andrew R
Division of Ocular Immunology, Wilmer Eye Institute, 600 N. Wolfe St., Maumenee Building, 3rd floor, Baltimore, MD, 21287, USA.
Division of Neuro-Ophthalmology, Wilmer Eye Institute, Baltimore, MD, USA.
BMC Ophthalmol. 2021 Jan 6;21(1):14. doi: 10.1186/s12886-020-01769-3.
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.
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.
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.
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.
自身免疫性疾病背景下巩膜炎的发展已有充分记录。既往系列研究仅在因风湿病或眼部炎症转诊的患者中评估全身性自身免疫性疾病与巩膜炎之间的关系。这可能导致转诊偏倚。我们回顾了一个卫生系统电子病历（EMR）中所有患有全身性自身免疫性疾病和巩膜炎诊断的患者病历，以确定两者的患病率以及哪些疾病发生巩膜炎的相对风险最高。
在电子病历系统的既往病史和诊断标签中搜索巩膜炎和全身性炎症诊断信息，以及相关疾病的特定实验室值。通过搜索SNOMED临床术语和ICD - 10诊断编码来评估巩膜炎与全身性炎症疾病的交集。计算每种自身免疫性疾病的患病率、巩膜炎患病率、患有自身免疫性疾病且患巩膜炎的患者百分比、患有巩膜炎且患自身免疫性疾病的患者百分比；巩膜炎患者患有特定自身免疫性疾病的相对风险（RR）。
共检索了590万份病历，148,993例患者被确诊患有自身免疫性疾病。总体上最常见的自身免疫性疾病是HLA - B27相关疾病（n = 26,680；患病率0.45%）；类风湿关节炎（RA）（n = 19,923；患病率0.34%）。相反，2702例患者被确诊患有巩膜炎（患病率0.05%），其中31.4%患有相关的自身免疫性疾病。类风湿关节炎患者中患有自身免疫性疾病且患巩膜炎的患者比例最高。肉芽肿性多血管炎（GPA）在患有巩膜炎且患自身免疫性疾病的患者中所占比例最高。干燥综合征是与巩膜炎相关的第三大常见疾病，占病例的4.5%。0.3%的患者与幼年特发性关节炎（JIA）有关联。
虽然这是关于自身免疫性疾病与巩膜炎之间关联的最大规模回顾性研究，但研究结果与之前的研究相似，近三分之一的巩膜炎患者有潜在的自身免疫性疾病诊断。该研究的局限性包括病历编码的准确性；可搜索的电子病历系统中要有实验室检查结果。未来需要利用电子病历系统来明确全身性疾病与巩膜炎解剖位置之间的关联。
