Necrotising anterior scleritis in a late-onset rheumatoid arthritis (LORA) patient

Late-onset rheumatoid arthritis (LORA) is a clinically distinct entity from rheumatoid arthritis of younger onset (YORA). We present a case of necrotising anterior scleritis in an elderly lady with new-onset LORA that was initially thought to be infective. Oestrogen receptors have been identified on B cells, T cells, and macrophages with oestrogens demonstrated to increase their activation and enhance RA synovial inflammation. The presence of long-term oestrogen supplementation may have contributed to the development and perpetuation of her RA, thereby necessitating awareness of the possible immunomodulatory role of the sex steroids in immune-mediated diseases which affect the eye.