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RA Scleritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRA ScleritisSCE Rheumatology

A 42-year-old woman with longstanding seropositive rheumatoid arthritis develops severe, deep ocular pain and a violaceous red eye. Ophthalmological assessment confirms non-infectious anterior scleritis rather than episcleritis. Which statement best explains the greater clinical significance of scleritis in this setting?

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Reveal the answer and explanation

Correct answer: C — It can cause scleral necrosis and visual loss and may herald rheumatoid vasculitis requiring systemic treatment.

Explanation lettering: C = shown as B · E = shown as C · B = shown as D · D = shown as E

E is correct. Scleritis involves the sclera itself and may cause destructive inflammation, scleral thinning or necrosis and sight-threatening ocular complications. In RA, particularly with necrotising scleritis, it may be a marker of rheumatoid vasculitis and warrants coordinated ophthalmology–rheumatology assessment. Treatment is systemic and severity-dependent, ranging from oral NSAIDs or corticosteroids to DMARD or biologic therapy. Episcleritis is usually superficial, benign and self-limiting, making A and C incorrect. Scleritis does not necessarily parallel synovitis activity, so apparently controlled joints do not remove the risk (B). ANCA-associated vasculitis is an important differential, but RA is itself a major systemic association (D).

Reference: Promelle V, Goeb V, Gueudry J. Rheumatoid Arthritis Associated Episcleritis and Scleritis: An Update on Treatment Perspectives. Journal of Clinical Medicine. 2021;10:2118. https://pubmed.ncbi.nlm.nih.gov/34068884/