Giant cell arteritis and scleritis: A rare association

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Giant cell arteritis (GCA) is a large-vessel vasculitis affecting the elderly, often causing ischemic complications.
• Ocular involvement in GCA typically manifests as anterior ischemic optic neuropathy, leading to irreversible vision loss.
• Scleritis is a rare but significant ocular manifestation of GCA.

Observation:

• A patient with GCA presented with recurrent isolated scleritis (anterior and posterior, unilateral and bilateral) despite corticosteroid therapy.
• The patient exhibited corticosteroid dependence and resistance to methotrexate.
• Tocilizumab, an anti-IL6 biologic, was initiated due to treatment resistance.

Findings:

• Recurrent scleritis in GCA can occur independently of other systemic inflammatory markers.
• Corticosteroid dependence and methotrexate resistance present a therapeutic challenge in managing GCA-associated scleritis.
• Tocilizumab demonstrated potential efficacy in managing refractory GCA-related scleritis.

Implications:

• This case highlights the importance of considering scleritis in GCA, even without other overt signs of inflammation.
• Tocilizumab represents a viable therapeutic option for refractory GCA-associated scleritis.
• Further research is warranted to establish treatment guidelines for GCA-related scleritis, particularly concerning biologic therapies.