title: Scleritis and systemic disease association in a community-based referral practice.
abstract: OBJECTIVE
  To evaluate the association between scleritis and systemic disease in a non-university, non-tertiary referral practice and to describe our experience with scleritis treatment.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The medical records of patients with scleritis between 2001 and 2007 were reviewed for associated systemic disease.
  
  
  RESULTS
  In our series of 86 patients with scleritis, 55 patients (64.0%) had isolated scleritis while 31 patients (36.0%) had associated systemic-disease. Twenty-six patients (83.9%) with systemic disease had diagnosed systemic disease at the time of initial scleritis presentation, while 5 patients (16.1%) were diagnosed following systemic work-up. Those diagnosed after systemic work-up were more likely to have systemic vasculitic disease as opposed to a rheumatic or infectious disease. Patients with and without associated systemic disease were likely to require systemic therapy at similar rates (93.5% and 92.7%, respectively). Five patients with steroid-refractory scleritis were treated with infliximab (Remicade; Centocor Inc, Horsham, Pennsylvania, USA) and all responded without evidence of adverse effect. Seven patients were treated with mycophenolate mofetil (CellCept; Roche Laboratories, Nutley, New Jersey, USA), of which three improved.
  
  
  CONCLUSIONS
  The association between scleritis and systemic disease in a community-based referral practice may be lower than in tertiary referral or university-based centers. Although thorough systemic disease evaluation is warranted in scleritis patients, most patients with associated systemic disease will have such a diagnosis prior to the development of scleritis. The need to institute aggressive systemic therapy cannot be predicted by the presence of an associated systemic disease. Infliximab and mycophenolate mofetil are useful additions to the scleritis practitioner's armamentarium for steroid-refractory scleritis.
authors.affiliation: Department of Ophthalmology, George Washington University, Washington, DC, USA. veena.raiji@gmail.com
authors.forename: Veena Rao
authors.initials: VR
authors.lastname: Raiji
authors.forename: Alan Gary
authors.initials: AG
authors.lastname: Palestine
authors.forename: David Leland
authors.initials: DL
authors.lastname: Parver
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications* / Q000175:diagnosis; D002648:Child; D003153:Community Health Services; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012017:Referral and Consultation; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis; D015423:Scleritis / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab; D009173:Mycophenolic Acid