Scleritis and rheumatoid arthritis.

Holthouse (1893) presented an unusual case of ulceration of the conjunctiva and sclera in a patient who also suffered from rheumatoid arthritis and described the typical histology of the condition. Nevertheless, van der Hoeve (1934), in the first description of scleromalacia perforans, which occurred in three cases in association with a polyarthritis, regarded the condition as a primary degeneration of the sclera. Thereafter, however, the association of scleritis with rheumatoid arthritis and other connective tissue diseases has been well established (Watson and Lobascher, 1965; Sevel, 1967; Lyne and Pitkeathley, 1968) and is regarded as being due to the development of rheumatoid nodules within the sclera (Verhoeff and King, 1938; Edstr6m and Osterlind, 1948; Anderson and Margolis, 1952; Sevel, 1965; Smiley and Bywaters, 1967; Watson, Hayreh, and Awdry, 1968). The prevalence of scleritis in rheumatoid arthritis is not well established and has been thought to be a rare complication (Smiley and Bywaters, 1967). Smith (1957) found one case of scleral involvement recorded in a retrospective study of the records of 465 rheumatoid patients, and by personal communication, Sevel (1965) estimated the prevalence to be one in three thousand cases. This study has been directed at determining the prevalence and nature of scleritis in rheumatoid arthritis and the place of this complication in the natural history of rheumatoid disease.