RESEARCH - Idiopathic scleritis: immunologic markers as potential predictors of systemic autoimmune disease

[Guest guest]

Am J Ophthalmol. 2008 Mar;145(3):463-471. Epub 2007 Dec 3.

Immunologic markers as potential predictors of systemic autoimmune

disease in patients with idiopathic scleritis.

Lin P, Bhullar SS, Tessler HH, Goldstein DA.

Department of Ophthalmology, University of Illinois at Chicago,

Chicago, Illinois; University of California, San Francisco, San

Francisco, California.

PURPOSE: To determine the clinical value of serological testing in

patients with idiopathic scleritis. DESIGN: Retrospective case series.

METHODS: Medical records of patients with scleritis seen at an

institutional referral center over an 11-year period were reviewed.

RESULTS: Of 119 patients with scleritis seen at the University of

Illinois Uveitis Clinic, 91 (76.5%) patients had no known etiology at

initial presentation. Seventy of the 91 patients were tested for

rheumatoid factor (RF), 19 (27.1%) of whom had a positive result. Ten

(52.6%) of these RF positive patients were subsequently diagnosed with

rheumatoid arthritis (RA) during a mean follow-up of 10.6 months

(range, zero to 72 months), whereas only one of 51 (2.0%) RF negative

patients developed RA, producing an odds ratio for developing RA in RF

positive patients of 55.6 (95% confidence interval (CI) 7.8 to 369.8,

P = .00001). Of the 70 patients who were tested for anti-neutrophil

cytoplasmic antibody (ANCA), seven (10.0%) tested positive. Three

(42.9%) of the ANCA positive patients subsequently developed Wegener

granulomatosis (WG), whereas only two of 63 ANCA negative patients

(3.2%) developed WG during a mean follow-up of 8.4 months (range, zero

to 72 months). The odds ratio for developing WG in patients with

idiopathic scleritis and a positive ANCA screen compared with a

negative ANCA was 22.9 (95% CI 3.4 to 154.2, P = .006).

CONCLUSIONS: The likelihood of patients with idiopathic scleritis

developing RA and WG was increased if they had a positive RF or ANCA,

supporting the role of immunologic marker testing in patients who

present without systemic disease.

PMID: 18061135

http://www.ncbi.nlm.nih.gov/pubmed/18061135

--

Not an MD