Are there any situations in which you would consider starting steroid-sparing agents at the outset for patients with scleritis without any evidence of systemic rheumatic disease?  

The average duration of scleritis is 7 years. The duration distribution is a bell-shaped curve, meaning that some patients have shorter disease duration but others have longer disease duration. Unless the ANCA is positive or an obvious systemic disease is present, it is very hard to know who will ha...

Great question. I agree with Dr. @James Rosenbaum that if the disease is very severe and we cannot risk flaring or continued activity I would consider it, or with contraindications to steroids. If this is not the case, I would try to treat acutely with NSAID or steroid, and if the disease keeps...