Noninfectious Autoimmune Scleritis: Recognition, Systemic Associations, and Therapy

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Scleritis is a severe ocular inflammation frequently linked to systemic autoimmune conditions.
• Rheumatoid arthritis and ANCA-associated vasculitis are key systemic associations requiring rheumatologist vigilance.
• IgG4-related disease is a recently identified systemic association with scleritis.

Purpose of the Study:

• To guide rheumatology patients in recognizing scleritis.
• To identify systemic diseases associated with scleritis in rheumatology referrals.
• To inform treatment choices between conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic therapies for scleritis.

Main Methods:

• Review of recent data on scleritis and associated systemic diseases.
• Analysis of therapeutic strategies for scleritis management.
• Identification of evidence gaps in current treatment approaches.

Main Results:

• Scleritis can precede systemic autoimmune disease diagnosis, particularly vasculitis.
• Observational data predominantly guides current therapeutic decisions for scleritis.
• Rituximab shows increasing evidence of efficacy in refractory scleritis cases.

Conclusions:

• Prompt recognition and treatment of scleritis are essential to prevent vision loss and systemic complications.
• There is a need for head-to-head trials comparing csDMARDs and biologics for idiopathic scleritis.
• Randomized controlled trials are needed for the treatment of refractory scleritis.