Abstract
This paper presents the first reported case of risedronate-associated scleritis and conducts a review of bisphosphonates and inflammatory eye diseases. A case of scleritis associated with risedronate use in a 73-year-old Chinese woman is reported. The English medical literature was reviewed for bisphosphonates and their association with inflammatory eye diseases. Cases of ocular inflammation in patients taking bisphosphonates have been reported since the early 1990s. Reported cases include both nitrogen- and non-nitrogen-containing bisphosphonates and with both intravenous and oral use. We report the first case of risedronate-induced scleritis. The case involves a 73-year-old woman who developed scleritis following exposure to risedronate in 2007 with recurrence of scleritis upon risedronate exposure again in 2009. Discontinuation of risedronate and treatment with intravenous and topical corticosteroids resulted in both clinical and radiological improvements within 24 h. Applying Naranjo's adverse drug reaction probability scale, a causality assessment was made which categorized this reaction as definite with a score of 9. In our case, there was a strong causal relationship between the use of risedronate and scleritis. Although rare, ocular adverse effects of bisphosphonates may be serious and should be made known to prescribing physicians. This is important in the practice of rheumatology as many of the patients are prescribed this class of medication for either prevention or treatment of osteoporosis. Moreover, ocular inflammation can be a sign of systemic disease, and such patients may be referred to a rheumatologist.
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References
Barrera BA, Wilton L, Harris S, Shakir SA (2006) Ophthalmological events in patients receiving risedronate: summary of information gained through follow-up in a prescription-event monitoring study in England. Drug Saf 29(2):151–160
Siris ES (1993) Bisphosphonates and iritis. Lancet 341(8842):436–437
French DD, Margo CE (2008) Postmarketing surveillance rates of uveitis and scleritis with bisphosphonates among a national veteran cohort. Retina 28(6):889–893
Dicuonzo G, Vincenzi B, Santini D et al (2003) Fever after zoledronic acid administration is due to increase in TNF- and IL-6. J Interferon Cytokine Res 23:649–654
Banal F, Briot K, Ayoub G, Dougados M, Roux C (2008) Unilateral anterior uveitis complicating zoledronic acid therapy in prostate cancer. J Rheumatol 35(12):2458–2459
Viñas G, Olivé A, Holgado S, Crsosta J (2002) Episcleritis secondary to risedronate. Med Clin (Barc) 118(15):598–599, Review. In Spanish
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30(2):239–245
Barrera BA, Wilton L, Harris S, Shakir SA (2005) Prescription-event monitoring study on 13,164 patients prescribed risedronate in primary care in England. Osteoporos Int 16(12):1989–1998
McKague M, Jorgenson D, Buxton KA (2010) Ocular side effects of bisphosphonates: a case report and literature review. Can Fam Physician 56(10):1015–1017
Tabbara KF (2008) Nodular scleritis following alendronate therapy. Ocul Immunol Inflamm 16(3):99–101
Colucci A, Modorati G, Miserocchi E, Di Matteo F, Rama P (2009) Anterior uveitis complicating zoledronic acid infusion. Ocul Immunol Inflamm 17(4):267–268
Leung S, Ashar BH, Miller RG (2005) Bisphosphonate-associated scleritis: a case report and review. South Med J 98(7):733–735, Review
Raja V, Sandanshiv P, Neugebauer M (2007) Risedronate induced transient ocular myasthenia. J Postgrad Med 53(4):274–275
Ramasamy B, Quah S, Sahni JN, Palimar P (2007) Bilateral severe fibrinous anterior uveitis—an unusual complication of pamidronate therapy exacerbated by topical latanoprost. J Ocul Pharmacol Ther 23(5):513–515
Stewart GO, Stuckey BG, Ward LC, Prince RL, Gutteridge DH, Constable IJ (1996) Iritis following intravenous pamidronate. Aust N Z J Med 26(3):414–415
Fietta P, Manganelli P, Lodigiani L (2003) Clodronate induced uveitis. Ann Rheum Dis 62(4):378
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We would like to thank Ms. Sonja Detillieux for her contribution to this case.
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Hemmati, I., Wade, J. & Kelsall, J. Risedronate-associated scleritis: a case report and review of the literature. Clin Rheumatol 31, 1403–1405 (2012). https://doi.org/10.1007/s10067-012-2035-z
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DOI: https://doi.org/10.1007/s10067-012-2035-z