Necrotising anterior scleritis in a late-onset rheumatoid arthritis (LORA) patient.
Late-onset rheumatoid arthritis (LORA) is a clinically distinct entity from rheumatoid arthritis of younger onset (YORA). We present a case of necrotising anterior scleritis in an elderly lady with new-onset LORA that was initially thought to be infective. Oestrogen receptors have been identified on B cells, T cells, and macrophages with oestrogens demonstrated to increase their activation and enhance RA synovial inflammation. The presence of long-term oestrogen supplementation may have contributed to the development and perpetuation of her RA, thereby necessitating awareness of the possible immunomodulatory role of the sex steroids in immune-mediated diseases which affect the eye.
Ooi
Kenneth G-J
KG
Bathurst Eye Clinic, Bathurst, NSW, Australia. kgjooi@yahoo.com.au
Wingate
Richard
R
Adler
Paul A
PA
D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications*; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012590:Sclera / Q000473:pathology; D015423:Scleritis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D013997:Time Factors
D018501:Antirheumatic Agents; D004967:Estrogens; D005938:Glucocorticoids; D011241:Prednisone; D008727:Methotrexate