Manifestações destrutivas da córnea e esclera associadas a doenças do tecido conectivo: relato de 9 casos

Santos, Nuno M.S. dos; Sousa, Luciene Barbosa de; Trevisani, Virgínia Fernandes Moça; Freitas, Denise de; Vieira, Luis Antonio

doi:10.1590/s0004-27492004000400022

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…9,10 Multiple infections can determine corneal ulcer; thus, the differential diagnosis is critical. 10 Approximately 50% of cases of non-infectious peripheral ulcerative keratitis are associated with some connective tissue disease, 5,11 especially rheumatoid arthritis. Other etiologies include polyarteritis nodosa, relapsing polychondritis, vasculitis associated with ANCA, for example, granulomatosis with polyangiitis (Wegener's) and granulomatosis with eosinophilic polyangiitis (Churg-Strauss syndrome).…”

Section: Discussionmentioning

confidence: 99%

Infliximab is effective in difficult-to-control peripheral ulcerative keratitis. A report of three cases

Zandavalli¹,

Castro²,

Mazzucco³

et al. 2015

Revista Brasileira de Reumatologia (English Edition)

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r e v b r a s r e u m a t o l . 2 0 1 5;5 5(3):310-312 w w w . r e u m a t o l o g i a . c o m . b r a b s t r a c t Peripheral ulcerative keratitis is caused by an inflammatory and destructive process of the perilimbal peripheral cornea. This inflammation is due to immune complex deposition in this region of the cornea and in adjacent vessels. It can be idiopathic, or a manifestation of systemic disease such as rheumatoid arthritis, vasculitis of small vessels associated with ANCA, relapsing polychondritis, systemic lupus erythematosus and Crohn's disease. Its treatment includes the use of high-dose corticosteroids and, in some cases, the concomitant use of immunosuppressants such as methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide or cyclosporine. The use of immunobiological agents can be a strategy in cases of difficult control. The authors describe the treatment of three patients who, after failure with the use of corticosteroids or immunosuppressants, showed good response after the use of infliximab. Infliximabe é eficaz em ceratite ulcerada periférica de difícil controle. Um relato de três casos Palavras-chave: Ceratite Úlcera de córnea Anticorpo monoclonal r e s u m o Ceratite ulcerada periférica é causada por um processo inflamatório e destrutivo da córnea periférica perilimbar. Essa inflamação se deve à deposição de imunocomplexos nessa região da córnea e nos vasos adjacentes a ela. Pode ser idiopática ou uma manifestação de doença sistêmica como artrite reumatoide, vasculites de pequenos vasos associadas ao ANCA, à policondrite recidivante, ao lúpus eritematoso sistêmico e à doença de Crohn. O tratamento inclui o uso de corticoide em dose alta e em alguns casos o uso concomitante de imunossupressores, como metotrexate, azatioprina, micofenolato mofetil, ciclofosfamida ou ciclosporina. O uso de agentes imunobiológicos pode ser uma estratégia nos casos de

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Section: Discussionmentioning

confidence: 99%

Infliximab is effective in difficult-to-control peripheral ulcerative keratitis. A report of three cases

Zandavalli¹,

Castro²,

Mazzucco³

et al. 2015

Revista Brasileira de Reumatologia (English Edition)

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“…This treatment starts with corticoid eye drops associated with NSAID, followed by the use of systemic corticoids (18) . Patients who continued to have eye inflammation (red eye or eye pain) were further treated with immunosuppressors such as methotrexate (MTX) 7.5 to 15 mg/week, azathioprine (AZA) 100 mg/day, cyclosporine A (CsA) 3.0 to 5.0 mg/kg/day, mycophenolate mofetil 2 g/day, clorambucil 0.1 mg/kg/day, leflunomide 20 mg/day or cyclophosphamide pulse therapy of 15/mg/day once a month for four months (19) .…”

Section: Treatmentmentioning

confidence: 99%

Comparative study of ophthalmological and serological manifestations and the therapeutic response of patients with isolated scleritis and scleritis associated with systemic diseases

Sousa

Trevisani

Modolo

et al. 2011

Arq. Bras. Oftalmol.

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Introduction: Scleritis is a rare, progressive and serious disease, the signs of which are inflammation and edema of episcleral and scleral tissues and is greatly associated with systemic rheumatoid diseases. Purpose: To perform a prospective and comparative study between ophthalmologic manifestations, serologic findings and therapeutic response of patients with isolated scleritis and scleritis associated with systemic rheumatoid disease. Methods: Thirty-two outpatients with non-infectious scleritis were studied, from March 2006 to March 2008. The treatment was corticoid eye drops associated with antiinflammatory agents, followed by systemic corticoids and immunosuppressive drugs if necessary, was considered successful after six months without scleritis recurrence. Results: Fourteen of 32 patients had scleritis associated with systemic rheumatoid disease, of which nine had rheumatoid arthritis, two systemic lupus erythematosus, one Crohn's disease, one Behçet's disease and one gout. There were no difference in relation to involvement and ocular complications, there was predominance of nodular anterior scleritis and scleral thinning was the most frequent complication. The scleritis associated with systemic rheumatoid disease group had 64.3% of autoantibodies, versus 27.8% among those with isolated scleritis and this difference was statistically significant. In the isolated scleritis group 16.7% used anti-inflammatory, 33.3% corticosteroids, 27.8% corticosteroids with one immunosuppressive drug, 5.5% two immunosuppressive drugs, 16.7% corticosteroids with two immunosuppressive drugs and 33.3% pulse of immunosuppressive drugs, there was remission in 88.9%. In the scleritis associated with systemic rheumatoid disease group 7.1% used anti-inflammatory, 7.1% corticosteroids, 50% corticosteroids with one immunosuppressive drug, 7.1% two immunosuppressive drugs and 22.2% pulse of immunosuppressive drugs, 100% had treatment success. Conclusion: Prevalence of unilateral nodular scleritis was noted in both groups and higher rates of all the parameters tested were noted in the scleritis associated with systemic rheumatoid disease group. There were no differences between the groups with respect to the use of immunosuppressive drugs and therapeutic response, which was fully satisfactory in the scleritis associated with systemic rheumatoid disease group and satisfactory in the isolated scleritis group.

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Manifestações destrutivas da córnea e esclera associadas a doenças do tecido conectivo: relato de 9 casos

Cited by 2 publications

References 13 publications

Infliximab is effective in difficult-to-control peripheral ulcerative keratitis. A report of three cases

Infliximab is effective in difficult-to-control peripheral ulcerative keratitis. A report of three cases

Comparative study of ophthalmological and serological manifestations and the therapeutic response of patients with isolated scleritis and scleritis associated with systemic diseases

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