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(The following reply to Dr. Oliver's letter was solicited by the Editor.)
Dear Dr. Oliver:
Treatment of your patient with rheumatoid arthritis and episcleritis offers real difficulty. Since he developed vasculitis and peripheral neuritis while receiving steroids, it would surely be unwise to give any more steroids systemically. The development of diffuse, severe vasculitis while on steroids is one of the most serious complications of this type of therapy. The vasculitis is often progressive with fatal outcome. The consensus of opinion is that vasculitis, of some degree, occurs in all patients with rheumatoid arthritis. It may occasionally become "malignant" in patients not treated with steroids, but such treatment surely enhances the likelihood of such progression.In regard to the treatment of the episcleritis, I think local steroid treatment is indicated and can be used safely. In so far as I know, there has been no increased incidence of severity of
Ropes MW. RHEUMATOID ARTHRITIS AND VASCULITIS-Reply. Arch Ophthalmol. 1961;66(1):154. doi:10.1001/archopht.1961.00960010155034