Corneal and scleral involvement in inflammatory rheumatic disease: Rheumatologists and ophthalmologists exchanging views - 08/03/19
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Highlights |
• | Inflammatory ocular disorders must be managed jointly by the ophthalmologist and rheumatologist or internist. |
• | The corneal and scleral disorders seen in patients with inflammatory rheumatic diseases cover a broad spectrum encompassing sicca syndrome, episcleritis, scleritis, and peripheral ulcerative keratitis (PUK). Scleritis and PUK are potentially severe. |
• | When an inflammatory ocular disorder occurs in a patient who has not been previously diagnosed with a systemic inflammatory disease, the rheumatologist or internist must guide the choice of investigations aimed at identifying the cause. |
• | Intensification of the systemic treatment should be considered if scleritis or PUK develops, as both conditions are reliable markers of disease severity. |
Abstract |
Corneal and scleral disorders related to inflammatory rheumatic diseases vary both in frequency and in severity. Sicca syndrome and its complications are the most common ocular manifestations and, together with episcleritis, can usually be managed by topical treatments. In contrast, the various forms of scleritis and peripheral ulcerative keratitis generally require systemic glucocorticoid therapy and the initiation or intensification of immunosuppressive treatment. Corneal and scleral manifestations are inaugural in a few patients with chronic inflammatory rheumatic disease. No direct information is available on the frequency of severe corneal and scleral involvement, which can only be estimated by extrapolating data from case-series or cohorts, many of which are historical. Similarly, given the absence of randomized controlled trials, treatment decisions must rely on clinical experience acquired in referral centers and on reports of small case-series studies. The rheumatologist and ophthalmologist must work closely together to ensure the prompt and optimal management of these potentially serious conditions.
Le texte complet de cet article est disponible en PDF.Keywords : Inflammatory joint disease, Rheumatoid arthritis, Scleritis, Peripheral ulcerative keratitis, Treatment
Plan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?