Etiological diagnosis of scleritis: contribution of the extra-ophthalmological clinical examination and paraclinical tests
Accept poster if oral is not possible ?
Yes
Purpose
Determining the etiology of scleritis is challenging. About one-third of cases are linked to systemic disease. This study aims to assess the value of extra-ophthalmological examination, additional tests and repeated etiological assessments during follow-up of presumed idiopathic scleritis.
Methods
We retrospectively reviewed 98 undetermined scleritis patients from 2 internal medicine departments in Lyon between July 2011 and September 2023. Data were collected at first presentation before any etiological diagnosis. The main outcome was the contribution of extra-ophthalmological clinical features to the etiological assessment.
Results
At the end of the follow-up, an association with a disease was found in 37 patients (38%). Extra-ophthalmologic signs provided etiological orientation in 20 (20%) cases. In three-quarters of the cases, the clinical signs predated the episode of scleritis. Ear, nose and throat (ENT) and skin signs were the most relevant, principally ENT for granulomatosis with polyangiitis (GPA). In our series, the positive predictive value (PPV) of non-specific Anti Neutrophil Cytoplasmic Antigen (ANCA) was 29%, while the negative predictive value (NPV) was 97%. When specificity was considered, the PPV increased to 86%. In 50% of the undetermined scleritis cases, a new ANCA test was performed with a mean delay of 22 months, but no assays were positive.
Conclusion
Clinical general examination contributed to the etiological diagnosis in 20% of presumed idiopathic scleritis cases. Our findings highlight the diagnostic value of ANCA with specificity, particularly in GPA, and suggest that follow-up etiological workups should be guided by new systemic clinical signs.
Conflict of interest
No
1
Last name
VASSENEIX
Initials of first name(s)
C
Department
Ophthalmology
City
Lyon
Country
France, Metropolitan
2
Last name
SOUBRIER
Initials of first name(s)
M
Department
Ophthalmology
City
Lyon
Country
France, Metropolitan
3
Last name
JACQUOT
Initials of first name(s)
R
Department
Internal Medicine
City
Lyon
Country
France, Metropolitan
4
Last name
BERT
Initials of first name(s)
A
Department
Internal Medicine
City
Lyon
Country
France, Metropolitan
5
Last name
GERFAUD-VALENTIN
Initials of first name(s)
M
Department
Internal Medicine
City
Lyon
Country
France, Metropolitan
6
Last name
KODJIKIAN
Initials of first name(s)
L
Department
Ophthalmology
City
Lyon
Country
France, Metropolitan
7
Last name
SEVE
Initials of first name(s)
P
Department
Internal Medicine
City
Lyon
Country
France, Metropolitan
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