John H Kempen1, Maxwell Pistilli2, Hosne Begum3, Tonetta D Fitzgerald4, Teresa L Liesegang5, Abhishek Payal6, Nazlee Zebardast7, Nirali P Bhatt4, C Stephen Foster8, Douglas A Jabs9, Grace A Levy-Clarke10, Robert B Nussenblatt11, James T Rosenbaum12, H Nida Sen11, Eric B Suhler13, Jennifer E Thorne14. 1. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA; MCM Eye Unit, MyungSung Christian Medical Center and Medical College, Addis Ababa, Ethiopia. Electronic address: kempenjh@yahoo.com. 2. Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3. Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD. 4. Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5. Department of Ophthalmology, Oregon Health & Sciences University, Portland, OR. 6. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; Veterans Affairs Boston Healthcare System, Boston, MA; Harvard Medical School, Boston, MA. 7. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA. 8. Harvard Medical School, Boston, MA; Massachusetts Eye Research and Surgery Institution, Waltham, MA. 9. Departments of Ophthalmology and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 10. Tampa Bay Uveitis Center, St. Petersburg, FL. 11. Laboratory of Immunology, National Eye Institute, Bethesda, MD. 12. Departments of Ophthalmology and Medicine, Oregon Health & Sciences University, Portland, OR; Legacy Devers Eye Institute, Portland, OR. 13. Department of Ophthalmology, Oregon Health & Sciences University, Portland, OR; Portland Veterans Affairs Medical Center, Portland, OR. 14. Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Abstract
PURPOSE: To assess how often non-infectious anterior scleritis remits and identify predictive factors. METHODS: Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. RESULTS: During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. CONCLUSIONS: Our results suggest scleritis remission occurs more slowly in anterior scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance scleritis remission (as suggested here) are needed.
PURPOSE: To assess how often non-infectious anterior scleritis remits and identify predictive factors. METHODS: Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. RESULTS: During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. CONCLUSIONS: Our results suggest scleritis remission occurs more slowly in anterior scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance scleritis remission (as suggested here) are needed.