Evaluation of patients with scleritis for systemic disease

Esen Karamursel Akpek, Jennifer E. Thorne, Faqir A. Qazi, Diana V. Do, Douglas A. Jabs

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

Objective: To evaluate the relationship between associated medical conditions and scleritis - particularly, the timing of the diagnosis of these diseases. Design: Retrospective case series. Participants: Patients with scleritis presenting to a single center over an 18-year period. Methods: Medical records were reviewed for the presence of an associated infectious or rheumatic disease and for the timing of the diagnosis of the systemic disease relative to the presentation for evaluation of the scleritis. Main Outcome Measures: Presence of an associated medical condition and timing of diagnosis relative to that of scleritis. Results: In a series of 243 patients with scleritis, 44.0% had an associated medical condition: 7.0%, an infection, and 37.0%, a rheumatic disease. The most frequent infection was herpes zoster, and the most frequent rheumatic disease was rheumatoid arthritis, present in 4.5% and 15.2% of patients, respectively. Of the 107 patients with an underlying disease, 77.6% had a previously diagnosed disease, 14.0% had their conditions diagnosed as a result of the initial evaluation, and 8.4% developed a systemic disease during follow-up. Systemic vasculitis was less likely to have been previously diagnosed than other rheumatic diseases (59.1% vs. 83.8%, P = 0.015) and more likely to be diagnosed by the initial diagnostic evaluation (27.3% vs. 8.8%, P = 0.027). Ten patients (4.1%) had a positive antineutrophil cytoplasmic antibody (ANCA) test result without clinical evidence of a systemic vasculitis. Four of 5 patients with a positive cytoplasmic ANCA test result but no clinical evidence of systemic vasculitis required immunosuppressive drugs for control of the scleritis, whereas 1 of the 5 patients with a positive perinuclear ANCA test result required immunosuppressive drugs. Among patients with no evident systemic disease after the initial diagnostic evaluation, the rate of occurrence of a rheumatic disease was 4% per person-year. Conclusions: Although associated systemic diseases are frequent among patients with scleritis, the majority are previously diagnosed. Systemic vasculitis is less likely than other rheumatic diseases to have been previously diagnosed. Because vasculitis is a potentially life-threatening disorder, it should be a focus of the diagnostic evaluation.

Original languageEnglish (US)
Pages (from-to)501-506
Number of pages6
JournalOphthalmology
Volume111
Issue number3
DOIs
StatePublished - Mar 2004

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Scleritis
Rheumatic Diseases
Systemic Vasculitis
Antineutrophil Cytoplasmic Antibodies
Immunosuppressive Agents
Drug and Narcotic Control
Herpes Zoster
Vasculitis
Infection
Medical Records
Communicable Diseases
Rheumatoid Arthritis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Akpek, E. K., Thorne, J. E., Qazi, F. A., Do, D. V., & Jabs, D. A. (2004). Evaluation of patients with scleritis for systemic disease. Ophthalmology, 111(3), 501-506. https://doi.org/10.1016/j.ophtha.2003.06.006

Evaluation of patients with scleritis for systemic disease. / Akpek, Esen Karamursel; Thorne, Jennifer E.; Qazi, Faqir A.; Do, Diana V.; Jabs, Douglas A.

In: Ophthalmology, Vol. 111, No. 3, 03.2004, p. 501-506.

Research output: Contribution to journalArticle

Akpek, EK, Thorne, JE, Qazi, FA, Do, DV & Jabs, DA 2004, 'Evaluation of patients with scleritis for systemic disease', Ophthalmology, vol. 111, no. 3, pp. 501-506. https://doi.org/10.1016/j.ophtha.2003.06.006
Akpek, Esen Karamursel ; Thorne, Jennifer E. ; Qazi, Faqir A. ; Do, Diana V. ; Jabs, Douglas A. / Evaluation of patients with scleritis for systemic disease. In: Ophthalmology. 2004 ; Vol. 111, No. 3. pp. 501-506.
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abstract = "Objective: To evaluate the relationship between associated medical conditions and scleritis - particularly, the timing of the diagnosis of these diseases. Design: Retrospective case series. Participants: Patients with scleritis presenting to a single center over an 18-year period. Methods: Medical records were reviewed for the presence of an associated infectious or rheumatic disease and for the timing of the diagnosis of the systemic disease relative to the presentation for evaluation of the scleritis. Main Outcome Measures: Presence of an associated medical condition and timing of diagnosis relative to that of scleritis. Results: In a series of 243 patients with scleritis, 44.0{\%} had an associated medical condition: 7.0{\%}, an infection, and 37.0{\%}, a rheumatic disease. The most frequent infection was herpes zoster, and the most frequent rheumatic disease was rheumatoid arthritis, present in 4.5{\%} and 15.2{\%} of patients, respectively. Of the 107 patients with an underlying disease, 77.6{\%} had a previously diagnosed disease, 14.0{\%} had their conditions diagnosed as a result of the initial evaluation, and 8.4{\%} developed a systemic disease during follow-up. Systemic vasculitis was less likely to have been previously diagnosed than other rheumatic diseases (59.1{\%} vs. 83.8{\%}, P = 0.015) and more likely to be diagnosed by the initial diagnostic evaluation (27.3{\%} vs. 8.8{\%}, P = 0.027). Ten patients (4.1{\%}) had a positive antineutrophil cytoplasmic antibody (ANCA) test result without clinical evidence of a systemic vasculitis. Four of 5 patients with a positive cytoplasmic ANCA test result but no clinical evidence of systemic vasculitis required immunosuppressive drugs for control of the scleritis, whereas 1 of the 5 patients with a positive perinuclear ANCA test result required immunosuppressive drugs. Among patients with no evident systemic disease after the initial diagnostic evaluation, the rate of occurrence of a rheumatic disease was 4{\%} per person-year. Conclusions: Although associated systemic diseases are frequent among patients with scleritis, the majority are previously diagnosed. Systemic vasculitis is less likely than other rheumatic diseases to have been previously diagnosed. Because vasculitis is a potentially life-threatening disorder, it should be a focus of the diagnostic evaluation.",
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AB - Objective: To evaluate the relationship between associated medical conditions and scleritis - particularly, the timing of the diagnosis of these diseases. Design: Retrospective case series. Participants: Patients with scleritis presenting to a single center over an 18-year period. Methods: Medical records were reviewed for the presence of an associated infectious or rheumatic disease and for the timing of the diagnosis of the systemic disease relative to the presentation for evaluation of the scleritis. Main Outcome Measures: Presence of an associated medical condition and timing of diagnosis relative to that of scleritis. Results: In a series of 243 patients with scleritis, 44.0% had an associated medical condition: 7.0%, an infection, and 37.0%, a rheumatic disease. The most frequent infection was herpes zoster, and the most frequent rheumatic disease was rheumatoid arthritis, present in 4.5% and 15.2% of patients, respectively. Of the 107 patients with an underlying disease, 77.6% had a previously diagnosed disease, 14.0% had their conditions diagnosed as a result of the initial evaluation, and 8.4% developed a systemic disease during follow-up. Systemic vasculitis was less likely to have been previously diagnosed than other rheumatic diseases (59.1% vs. 83.8%, P = 0.015) and more likely to be diagnosed by the initial diagnostic evaluation (27.3% vs. 8.8%, P = 0.027). Ten patients (4.1%) had a positive antineutrophil cytoplasmic antibody (ANCA) test result without clinical evidence of a systemic vasculitis. Four of 5 patients with a positive cytoplasmic ANCA test result but no clinical evidence of systemic vasculitis required immunosuppressive drugs for control of the scleritis, whereas 1 of the 5 patients with a positive perinuclear ANCA test result required immunosuppressive drugs. Among patients with no evident systemic disease after the initial diagnostic evaluation, the rate of occurrence of a rheumatic disease was 4% per person-year. Conclusions: Although associated systemic diseases are frequent among patients with scleritis, the majority are previously diagnosed. Systemic vasculitis is less likely than other rheumatic diseases to have been previously diagnosed. Because vasculitis is a potentially life-threatening disorder, it should be a focus of the diagnostic evaluation.

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