Remission Of Non-Infectious Anterior Scleritis: Incidence And Predictive Factors. Am J Ophthalmol 2019;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 1,391 years' aggregate follow-up of 825 affected eyes, remission occurred in 399 (299 of 588 patients). Median time-to-remission of scleritis=3.1 years (95% confidence interval (CI): 2.6, 3.9). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio (aHR)=0.57, 95% CI: 0.42-0.75); and diagnosis with any systemic inflammatory disease (aHR=0.59, 95% CI: 0.39-0.87), or specifically with Rheumatoid Arthritis (aHR=0.64), Granulomatosis with Polyangiitis (aHR=0.21), or Systemic Lupus Erythematosus (aHR=0.32). Angiotensin Converting Enzyme (ACE) Inhibitor treatment (aHR=1.69, 95% CI: 1.18-2.35) within ≤90 days was associated with more remission incidence. CONCLUSIONS: Our results suggest scleritis remission occurs in a majority by 3.1 years (less than in newly diagnosed anterior uveitis but more than intermediate uveitis), suggesting that periodic attempts at tapering suppressive medications is warranted. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive ACE inhibitor or statin treatment truly can enhance scleritis remission (as suggested here) are needed.