Which of the following is one of the two most common collagen vascular diseases associated with anterior scleritis?

• A. Rheumatoid arthritis
• B. Primary Sjogren's
• C. SLE
• D. Wegener's granulomatosis

Answer: (D)

Anterior scleritis is a flag for systemic inflammatory or vasculitic disease. Among collagen vascular diseases, two stand out as frequent associates: rheumatoid arthritis and granulomatosis with polyangiitis (formerly Wegener's granulomatosis). The sclera can be involved by the vasculitis and granulomatous inflammation seen in granulomatosis with polyangiitis, leading to painful, sometimes necrotizing scleritis. GPA often affects the respiratory tract and kidneys, and ocular involvement is a well-recognized feature, with scleritis being a common presentation. Because of this strong link, anterior scleritis should prompt evaluation for GPA, including serology such as c-ANCA (PR3-ANCA). The other options can involve the eye but are less commonly linked to anterior scleritis than GPA or rheumatoid arthritis, making granulomatosis with polyangiitis the best-supported association.