Drop in Scleritis Cases in UK Likely Due to Better Management of Immune Disease

By Megan Brooks

March 22, 2021

NEW YORK (Reuters Health) - The incidence of scleritis has fallen by about a third in the United Kingdom over roughly the past two decades, likely due to improvements in the management of immune-related diseases, researchers report.

"Scleritis is a potentially sight-threatening disease that is significantly associated with many infectious and immune-mediated inflammatory diseases and this highlights the importance of multi-specialty care pathways," Dr. Tasanee Braithwaite of The Medical Eye Unit, Guy's and St Thomas' Hospital, in London, told Reuters Health by email.

She and her colleagues used the National Health Service (NHS) primary-care electronic-patient-record database to estimate the U.K. incidence and prevalence of scleritis between 1997 and 2018.

Over this 22-year period, scleritis incidence declined from 4.2 to 2.8 per 100,000 person-years, they report in Arthritis and Rheumatology.

Dr. Braithwaite said the study did not directly explore the reasons for the decline, but her team believes a key factor was increased availability of funded biologic therapy for patients in the NHS over this period.

"Whilst no biologics have been approved for scleritis management by the UK's National Institute for Health and Care Excellence as yet (because of the lack of randomized controlled trials for this rare disease presentation), our clinical experience is that numerous biologics are very effective, and indeed, vitally sight-saving in scleritis that is refractory to steroids and other immunosuppressive agents," Dr. Braithwaite told Reuters Health.

The study also found significant associations between incident scleritis and previous or subsequent diagnosis of more than a dozen different immune-mediated inflammatory diseases, which are increasingly managed with biologic therapy in the U.K., Dr. Braithwaite said.

These included granulomatosis with polyangiitis, Behcet's disease, rheumatoid arthritis, the HLAB27-associated spondyloarthropathies, and systemic lupus erythematosus.

Dr. Braithwaite cautioned that generalizing the findings from one epidemiological study to another population is always challenging.

"It is possible that a similar trend, of declining scleritis incidence, might be anticipated in comparable high-income populations with comparable access to biologics," she told Reuters Health.

"We might not anticipate a similar trend in low and middle-income regions, where the prevalence of infectious diseases associated with scleritis is much higher, and access to effective eye care services and immunosuppressive treatments, including high-cost biologics, far more limited," she added.

Dr. Braithwaite received salary support from patient charity Olivia's Vision. The authors have no conflicts of interest.

SOURCE: https://bit.ly/3qTNOBq Arthritis and Rheumatology, online March 16, 2021.