Scleritis in patients with granulomatosis with polyangiitis (Wegener)

被引:30
作者
Cocho, Lidia [1 ,2 ]
Gonzalez-Gonzalez, Luis Alonso [1 ,2 ]
Molina-Prat, Nicolas [3 ]
Doctor, Priyanka [1 ,2 ]
Sainz-de-la-Maza, Maite [4 ]
Foster, C. Stephen [1 ,2 ,5 ]
机构
[1] MERSI, Waltham, MA USA
[2] Ocular Immunol & Uveitis Fdn, Waltham, MA USA
[3] Inst Oftalmol Integral, Santiago, Chile
[4] Hosp Clin Barcelona, Inst Clin Ophthalmol, Ophthalmol Serv, Barcelona, Spain
[5] Harvard Med Sch, Dept Ophthalmol, Boston, MA USA
关键词
DISEASE; FEATURES;
D O I
10.1136/bjophthalmol-2015-307460
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Aims To describe and compare clinical features, complications and outcomes in patients with granulomatosis with polyangiitis (GPA)-associated scleritis with those seen in idiopathic and other autoimmune-associated scleritis, and to further describe the features that may serve as an indicator of life-threatening systemic disease. Methods We retrospectively reviewed electronic health records of all patients with scleritis seen at two tertiary care centres. Of 500 patients, 14 had GPA-associated scleritis and were included in this analysis. Measures included were age, gender, laterality, visual acuity and underlying systemic or ocular diseases. Clinical features (location, pain, inflammation) and ocular complications of these patients (decrease of vision, concomitant anterior uveitis and ocular hypertension) were studied and correlated. Results Fourteen of 500 patients with scleritis were GPA associated. Most of the patients with GPA-associated scleritis presented with sudden onset, bilateral, diffuse anterior scleral inflammation, with moderate-or-severe pain. Vision loss was not significantly different, and pain was more severe in these patients than in those with idiopathic scleritis. When compared with patients with other underlying autoimmune diseases, there were no significant differences found in epidemiological or clinical signs. Necrotising scleritis and corneal involvement were more commonly observed in GPA than in idiopathic scleritis and other autoimmune diseases and are often the presenting feature of the disease. Conclusions The presence of necrotising changes or corneal involvement in the setting of scleral inflammation is highly suggestive of an underlying systemic vasculitis, of which GPA is the most common. These features should alert the doctor/optometrist and prompt a thorough diagnostic approach and an aggressive treatment given that it could reveal a life-threatening disease.
引用
收藏
页码:1062 / 1065
页数:4
相关论文
共 25 条
[1]   Diagnosis of limited ophthalmic wegener granulomatosis: Distinctive pathologic features with ANCA test confirmation [J].
Ahmed M. ;
Niffenegger J.H. ;
Jakobiec F.A. ;
Ben-Arie-Weintrob Y. ;
Gion N. ;
Androudi S. ;
Folberg R. ;
Raizman M.B. ;
Margo C.E. ;
Smith M.E. ;
McLean I.W. ;
Caya J.G. ;
Foster C.S. .
International Ophthalmology, 2008, 28 (1) :35-46
[2]   Evaluation of patients with scleritis for systemic disease [J].
Akpek, EK ;
Thorne, JE ;
Qazi, FA ;
Do, DV ;
Jabs, DA .
OPHTHALMOLOGY, 2004, 111 (03) :501-506
[3]  
Arnavaz AB, 1997, OPHTHALMOLOGE, V94, P595, DOI 10.1007/s003470050166
[4]   Five-year outcome in immune-mediated scleritis [J].
Bernauer, Wolfgang ;
Pleisch, Beat ;
Brunner, Matthias .
GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, 2014, 252 (09) :1477-1481
[5]  
de la Maza MS, 2002, ARCH OPHTHALMOL-CHIC, V120, P15
[6]  
DELAMAZA MS, 1994, OPHTHALMOLOGY, V101, P389
[7]  
DELAMAZA MS, 1995, OPHTHALMOLOGY, V102, P687, DOI 10.1016/S0161-6420(95)30970-0
[8]   Ocular manifestations of the potentially lethal rheumatologic and vasculitic disorders [J].
Foster, C. Stephen .
JOURNAL FRANCAIS D OPHTALMOLOGIE, 2013, 36 (06) :526-532
[9]   Scleritis and peripheral ulcerative keratitis [J].
Galor, Anat ;
Thorne, Jennifer E. .
RHEUMATIC DISEASE CLINICS OF NORTH AMERICA, 2007, 33 (04) :835-+
[10]   Clinical Features and Presentation of Infectious Scleritis from Herpes Viruses A Report of 35 Cases [J].
Gonzalez-Gonzalez, Luis Alonso ;
Molina-Prat, Nicolas ;
Doctor, Priyanka ;
Tauber, Joseph ;
Teresa Sainz de la Maza, Maria ;
Foster, C. Stephen .
OPHTHALMOLOGY, 2012, 119 (07) :1460-1464