From the Guidelines
UCTD (Undifferentiated Connective Tissue Disease) is an autoimmune condition that presents with symptoms of various connective tissue diseases but doesn't fully meet the criteria for any specific one, and episcleritis is an inflammatory condition affecting the episclera, which can be self-limiting and usually responds to topical corticosteroids and NSAIDs.
Definition and Treatment
UCTD typically causes fatigue, joint pain, muscle aches, mild fevers, and Raynaud's phenomenon, and may evolve into a defined disease like lupus or remain undifferentiated, with treatment usually involving anti-inflammatory medications, antimalarials like hydroxychloroquine (200-400mg daily), and sometimes low-dose corticosteroids 1. Episcleritis presents as redness, irritation, and mild discomfort in one or both eyes, often with a sectoral pattern of redness, and most cases resolve within 2-3 weeks, even without treatment, with management typically including artificial tears for comfort and, if needed, topical non-steroidal anti-inflammatory drugs like ketorolac 0.5% drops 4 times daily 1.
Association with Systemic Autoimmune Conditions
Interestingly, episcleritis can sometimes be associated with systemic autoimmune conditions like UCTD, so patients with recurrent episodes should be evaluated for underlying disorders, and treatment of episcleritis generally parallels UC activity, with simple episcleritis not requiring referral to an ophthalmologist and may self-resolve 1.
Key Points to Consider
- UCTD is an autoimmune condition with various symptoms
- Episcleritis is an inflammatory condition affecting the episclera
- Episcleritis can be self-limiting and usually responds to topical corticosteroids and NSAIDs
- Patients with recurrent episodes of episcleritis should be evaluated for underlying disorders like UCTD
- Treatment of episcleritis generally parallels UC activity, with simple episcleritis not requiring referral to an ophthalmologist and may self-resolve 1.
From the Research
Definition and Characteristics
- UCTD (Undifferentiated Connective Tissue Disease) is a condition characterized by the presence of clinical symptoms of a systemic autoimmune disease, along with laboratory evidence of autoimmunity, without fulfilling the classification criteria for classic autoimmune diseases 2.
- Episcleritis is a benign and self-limiting disease, often with a recurrent course, manifesting mainly in young adults, and affecting the episclera 3, 4.
- Scleritis, on the other hand, is an ocular inflammation with severe pain, affecting adjacent tissue, and is classified into anterior and posterior forms 3.
Associations and Complications
- Systemic diseases, such as rheumatoid arthritis or granulomatosis with polyangiitis, are associated with up to 50% of all patients with scleritis or episcleritis 3.
- UCTD can be subcategorized as evolving (eUCTD) or stable UCTD (sUCTD) based on its evolution towards a definable autoimmune syndrome, with 28% of patients developing SLE or rheumatoid arthritis within 5-6 years of diagnosis 2.
- Scleritis has a higher risk of complications, including visual loss, organ damage, and mortality, whereas episcleritis has a self-limited course 3, 4.
Treatment and Management
- Treatment of episcleritis is mainly symptomatic, with artificial tears, topical corticosteroids, and potentially systemic nonsteroidal anti-inflammatory drugs 4, 5.
- Scleritis requires early and aggressive anti-inflammatory treatment, with a stepwise approach, involving non-steroidal anti-inflammatory drugs, corticosteroids, and disease-modifying anti-rheumatic drugs 3, 4.
- UCTD treatment regimens are similar to other mild autoimmune diseases, with low-dose prednisone, hydroxychloroquine, and NSAID, and one-third of patients may require immune suppressive medications 2.