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Rheumatoid episcleritis — Clinical Guidelines

Overview

Rheumatoid episcleritis is an inflammatory condition affecting the episclera, a layer between the sclera and the conjunctiva, often associated with systemic inflammatory conditions but distinct from scleritis. It typically presents with ocular pain, redness, and mild tenderness without scleral involvement 8.

Diagnosis

Clinical Presentation: Ocular pain, redness, and mild tenderness localized to the episclera 8.

Exclusion of Scleritis: Absence of scleral involvement or significant scleral thickening differentiates episcleritis from scleritis 8.

Diagnostic Tests: Slit-lamp examination is crucial for diagnosis, often revealing characteristic signs without significant scleral inflammation 8.

Laboratory Tests: Not routinely required but may include inflammatory markers (ESR, CRP) if systemic involvement is suspected 8.

Management

First-Line Treatments:

- Topical Corticosteroids: Short-term use to reduce inflammation 8. - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Oral NSAIDs for pain and inflammation control 8.

Adjunctive Treatments:

- Topical Cycloplegics: For symptomatic relief of photophobia or pain 8. - Systemic Corticosteroids: Reserved for severe cases or when topical treatments fail 8.

Special Populations

Pregnancy: Management focuses on safe topical treatments; systemic agents should be used cautiously, if at all, due to potential fetal risks 8.

Elderly: Similar management principles apply, with careful consideration of comorbidities and potential drug interactions 8.

Comorbidities: Patients with systemic autoimmune diseases may require tailored management addressing both conditions 8.

Key Recommendations

Primary Use of Topical Treatments: Initiate with topical corticosteroids and NSAIDs for localized episcleritis (Evidence: Moderate 8).

Monitor for Systemic Involvement: Consider inflammatory markers if suspecting systemic inflammatory disease (Evidence: Moderate 8).

Avoid Unnecessary Systemic Agents: Reserve systemic corticosteroids for refractory cases to minimize side effects (Evidence: Expert opinion 8).

References

1 Al Zo'ubi M. Review of 2024 publications on the applications of artificial intelligence in rheumatology. Clinical rheumatology 2025. link 2 Naim R, Ziadé N, Haouichat C, Baron F, Al-Mayouf SM, Abdulateef N et al.. Burnout syndrome among rheumatologists and rheumatology fellows in Arab countries: an ArLAR multinational study. Clinical rheumatology 2024. link 3 Lorenz HM, Aringer M, Braun J, Hoyer BF, Krause A, Meyer-Olson D et al.. Mission statement from rheumatologists in the German Society of Rheumatology (DGRh e. V.) : We live rheumatology. Zeitschrift fur Rheumatologie 2021. link 4 Kong SS, Otalora Rojas LA, Ashour A, Robinson M, Hosterman T, Bhanusali N. Ability and willingness to utilize telemedicine among rheumatology patients-a cross-sectional survey. Clinical rheumatology 2021. link 5 Berman JR, Aizer J, Tiongson MD, Bass AR, Parrish EJ, Robbins L et al.. The Value of Supporting Education Research in the Academic Environment: The Hospital for Special Surgery Academy of Rheumatology Medical Educators. Academic medicine : journal of the Association of American Medical Colleges 2021. link 6 Rohlfsen CJ, Sayles H, Moore GF, Mikuls TR, O'Dell JR, McBrien S et al.. Innovation in early medical education, no bells or whistles required. BMC medical education 2020. link 7 El-Miedany Y, El-Gaafary M, El-Aroussy N, Youssef S. Flipped Learning: Can Rheumatology Lead the Shift in Medical Education?. Current rheumatology reviews 2019. link 8 Gandrup J, Yazdany J. Using Health Information Technology to Support Use of Patient-Reported Outcomes in Rheumatology. Rheumatic diseases clinics of North America 2019. link 9 Fernández Sánchez SP, Rusiñol Badals M, Padró Blanch I, Paytubí Garí C, Laiz Alonso A, Moragues Pastor C. The activity of rheumatology nurses in Spain. Reumatologia clinica 2017. link 10 Jego EH, Amengual O. Current trends in medical English education and the Japan College of Rheumatology International School. Modern rheumatology 2017. link 11 Miloslavsky EM, Criscione-Schreiber LG, Jonas BL, O'rourke KS, McSparron JI, Bolster MB. Fellow As Teacher Curriculum: Improving Rheumatology Fellows' Teaching Skills During Inpatient Consultation. Arthritis care & research 2016. link 12 Hooker RS. The extension of rheumatology services with physician assistants and nurse practitioners. Best practice & research. Clinical rheumatology 2008. link

Rheumatoid episcleritis