Background: We report two cases of patients with refractory scleritis associated with rheumatoid arthritis (RA) who responded to treatment with interleukin-6 (IL-6) inhibitors.
Case Presentation: Patient1 was a 52-year-old woman who had been treated for RA with oral methotrexate (MTX) and prednisolone (PSL) since the age of 25. The patient developed refractory scleritis and was referred to our hospital. Upon examination at our hospital, we noted recurrence of RA and scleritis as oral PSL dosage was reduced. Therefore, administration of biological drugs was considered. As the patient had a history of an anti-TNF-α preparation therapy, which was ineffective, tocilizumab (TCZ) was introduced. Two months later, the scleritis resolved, and there has been no recurrence since then. Patient 2 was a 44-year-old woman who was diagnosed with RA at the age of 33 and had been treated since then with MTX and etanercept (ETN). During the follow-up period, she developed scleritis that did not improve despite treatment with local and systemic steroids and was referred to our hospital. Upon her initial visit at our hospital, immunosuppressant eye drops for diffuse scleritis and an oral non-steroidal anti-inflammatory drug were additionally administered. Despite this, scleritis persisted. At the Department of Internal Medicine, where she was treated for RA, the biological drug was changed from ETN to TCZ as ETN was not effective. After TCZ introduction, scleritis was improved and was resolved at 3 months after initiating this introduction. There has been no subsequent recurrence since then.
Conclusions: This study reported two cases of patients with scleritis who were resistant for steroids, immunosuppressants, and anti-TNF-α therapy for RA but responded well to IL-6 inhibitors, indicating that IL-6 inhibitors is a potential treatment option for refractory scleritis.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 128-134, 2019.