Rituximab for treatment of scleritis associated with rheumatoid arthritis

Inflammatory eye involvement often complicates rheumatological disorders. Conventional disease-modifying anti-rheumatic drugs (DMARDs) are often not very effective in this situation. Cyclophosphamide or, more recently, tumour necrosis factor inhibitors (TNFi) have been used with some efficacy. In this report we present three cases where scleritis complicating rheumatoid arthritis (RA) was treated successfully by rituximab after inefficacy of cyclophosphamide or TNFi. A 74-year-old male with RA, maintained on hydroxychloroquine and sulfasalazine, presented with bilateral red eyes, a flare of synovitis in joints and high inflammatory markers. He was treated with six cycles of intravenous pulsed cyclophosphamide and methyl prednisolone but developed a severe pneumonia requiring hospitalisation for intravenous antibiotic therapy. However, his scleritis persisted. A cycle of two infusions of …