Successful Tocilizumab Treatment for Scleritis

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis often affecting older adults.
• Scleritis, a serious ocular inflammation, can be a rare complication of GCA.
• Conventional treatments for GCA-associated scleritis, including glucocorticoids and immunosuppressants, may be insufficient.

Observation:

• A 62-year-old female with a history of GCA presented with refractory scleritis and headaches.
• Previous treatments with NSAIDs, glucocorticoids, and various DMARDs provided only partial relief.
• Despite no laboratory evidence of active GCA, tocilizumab was initiated.

Findings:

• Tocilizumab rapidly resolved the patient's scleritis and headaches within days.
• The patient achieved full remission, allowing complete tapering of prednisone within 3 months.
• Sustained remission was maintained for 12 months post-tocilizumab initiation.

Implications:

• Tocilizumab demonstrates potential as a novel therapeutic agent for severe scleritis, particularly in GCA patients.
• This case suggests further investigation into IL-6 inhibition for managing refractory scleritis is warranted.
• Effective management of GCA-associated scleritis can prevent vision loss and improve patient quality of life.