Title:Necrotizing Scleritis and Rheumatoid Arthritis: A Clinical Case Report
Supported by A Brief Review with Risk of Bias Analysis
Volume: 19
Issue: 3
Author(s): Celso Busnelo Moreno, João Carlos Gonçalves Cruz, Idiberto Jose Zotarelli-Filho*, Maurélio de Lima Batista Ribeiro Junior, Marcello Novoa Colombo Barboza, Guilherme Novoa Colombo Barboza and Marta Fabiane Gouvêa Barioni
Affiliation:
- Department of Clinical Research, Faculty of Medicine of Sao Jose do Rio Preto, FACERES, Sao Paulo, Brazil
Keywords:
Scleritis, necrotizing scleritis, rheumatological diseases, autoimmune diseases, rheumatoid arthritis, biomicroscopy.
Abstract:
Introduction: Necrotizing scleritis (NS) presents 30%-40% as having a systemic autoimmune
condition.
Objective: To present a clinical case report and a systematic review of necrotizing scleritis with
ocular manifestation as the first sign of rheumatologic disease.
Methods: The present study was elaborated according to the rules of CARE.
Case Report: A female patient, 63 years old, a white, administrative assistant, presented irritation,
low visual acuity (LVA) in the left eye (LE), and headache. Biomicroscopy (BIO) in the right eye
(RE) was normal, and the LE showed hyperemia and scleral thinning. After 1 month, the patient returns
without signs of infectious diseases in the exams, and after a rheumatological evaluation with
a diagnosis of rheumatoid arthritis, methotrexate and prednisone are prescribed. After 2 months, she
relapsed and started treatment with anti-TNF, with remission after the 4th dose. After 1 year, she
evolved with LVA in LE.
Results: A total of 244 articles were found, 104 articles were evaluated and 10 were included in the
brief review. The symmetrical Funnel Plot does not suggest a risk of bias.
Conclusion: Both in the present case report and the literary findings, it was evidenced that the ophthalmologic
findings may precede the systemic changes of the disease for the early diagnosis of
rheumatoid arthritis.
