目的:巩膜炎可能是特发性的或由外伤引起的,感染,或免疫介导的疾病。我们的研究旨在了解巩膜炎与免疫介导疾病之间的关系,包括呈现特征,血清学,和治疗过程。了解这些关联可以使临床医生对患者进行风险分层并预测其临床和治疗过程。
方法:我们对2005年1月1日至2020年12月31日在三级护理中心就诊的341名巩膜炎患者进行了回顾性分析。人口统计,巩膜炎的特点,治疗反应,复发,我们比较了特发性和免疫介导的疾病相关巩膜炎患者的血清学数据.
结果:在看到的巩膜炎患者中,145名患者(43%)患有相关的免疫介导疾病,最常见的类风湿性关节炎(39%),血管炎(21%),或炎症性肠病(14%)。在大多数情况下,免疫介导的疾病诊断早于巩膜炎表现(65%),尽管血管炎病例更有可能在巩膜炎发作期间或之后发展。在有和没有相关免疫介导疾病的巩膜炎患者中,人口统计学或治疗失败没有显着差异。患有免疫介导疾病的患者更容易出现巩膜炎复发(62%vs49%,p=0.02)。
结论:在我们的眼科中心,43%的巩膜炎患者患有相关的免疫疾病,大多数免疫介导疾病的患者在出现巩膜炎之前就有该疾病的症状。类风湿性关节炎是最常见的相关疾病,通常早于巩膜炎,而在巩膜炎发作期间或之后更有可能诊断为血管炎。与特发性巩膜炎相比,免疫介导疾病患者的巩膜炎更有可能复发。
OBJECTIVE: Scleritis may be idiopathic or caused by trauma, infections, or an immune-mediated disease (IMD). Our study aimed to understand the relationship between scleritis and IMD, including presenting characteristics, serologies, and treatment course. Understanding these associations may allow clinicians to risk-stratify patients and predict their clinical and treatment course.
METHODS: We conducted a retrospective chart
review of 341 patients with
scleritis seen at a tertiary care center between January 1, 2005, and December 31, 2020. Demographics, scleritis characteristics, treatment response, recurrence, and serologic data were compared among patients with idiopathic and IMD-associated
scleritis.
RESULTS: Among patients with scleritis seen, 145 patients (43%) had an associated IMD, most commonly rheumatoid arthritis (RA; 39%), vasculitis (21%), or inflammatory bowel disease (14%). In most cases, the IMD diagnosis predated the scleritis presentation (63%), though vasculitis cases were more likely to develop during or after
scleritis episodes. There were no significant differences in demographics or treatment failures among patients with scleritis with and without associated IMDs. Patients with IMDs were more likely to have a recurrence of scleritis (62% vs 49%, P = 0.02).
CONCLUSIONS: At our ophthalmology center, 43% of patients with scleritis had an associated IMD, and most patients with an IMD were symptomatic from this disease prior to scleritis presentation. RA was the most commonly associated condition and typically predated the scleritis, whereas vasculitis was more likely diagnosed during or after the
scleritis episode.
Scleritis among patients with IMD is more likely to recur compared to
scleritis that is idiopathic.