Successful treatment of refractory anterior scleritis in primary Sjögren’s syndrome with rituximab
- 1Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Luebeck, and Rheumaklinik Bad Bramstedt, Ratzeburger Allee 160, 23538 Luebeck, Germany
- 2Department of Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, Hegewischstr. 2, 24105 Kiel, Germany
- Correspondence to:
Dr K Ahmadi-Simab
- Accepted 28 December 2004
Anterior scleritis is an inflammation of the superficial, subconjunctival sclera which may follow infection or occur in rheumatic disease. Anterior scleritis due to secondary immune complex mediated vasculitis is an extremely rare extraglandular manifestation in primary Sjögren’s syndrome.1 Symptoms of anterior scleritis are pain, tearing, and photophobia. If left untreated, anterior scleritis may progress to scleromalacia and, ultimately, threaten eyesight by affecting the uvea.2 Here we report on the successful induction of remission with the B cell directed monoclonal anti-CD20 antibody in a case of refractory anterior scleritis with episcleritis in primary Sjögren’s syndrome.
Primary Sjögren’s syndrome was diagnosed in a 60 year old white woman according to the criteria of the European study group.3 Ocular and oral sicca symptoms included for more than 3 months, a pathological Schirmer test (<5 mm/5 min), and pathological salivary scintigraphy. Antinuclear antibodies and Ro (SSA) were detected and, later on, anti-fodrin antibodies. Complement levels were normal, cryoglobulin was negative. The patient was treated for arthralgia with low dose steroids and hydroxychloroquine.