{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:54:03Z","timestamp":1781646843115,"version":"3.54.5"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Ophthal Inflamm Infect"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Necrotizing scleritis is a rare but severe ocular inflammatory disorder, frequently associated with systemic autoimmune diseases such as rheumatoid arthritis (RA). Although biologic agents targeting cytokines such as TNF-\u03b1 and IL-6 have improved disease outcomes, some patients remain refractory to these treatments. We describe a case of necrotizing scleritis resistant to multiple biologic agents that responded favorably to the Janus kinase (JAK) inhibitor upadacitinib.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 43-year-old woman with rheumatoid arthritis presented with bilateral conjunctival injection and left ocular pain. Despite systemic corticosteroid therapy (30\u00a0mg\/day) and switching between biologics, ocular inflammation and scleral thinning continued to progress. Consequently, oral administration of the selective JAK1 inhibitor upadacitinib (15\u00a0mg\/day) was initiated. Two months after treatment, ocular pain and redness resolved completely, with marked regression of nodular inflammation and stabilization of scleral thinning. Systemic corticosteroids were successfully tapered to 5\u00a0mg\/day, and the patient remained relapse-free for six months without any adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Upadacitinib, through selective inhibition of the JAK-STAT signaling pathway, provided rapid and sustained control of inflammation in a case of necrotizing scleritis unresponsive to biologic agents. Although this observation suggests that JAK inhibitors may represent a potential therapeutic option for refractory ocular inflammation, further studies are required to clarify their long-term efficacy and safety in patients with scleritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12348-026-00580-3","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:31:55Z","timestamp":1774859515000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Necrotizing scleritis resistant to biologics successfully managed with the JAK inhibitor upadacitinib: a case report"],"prefix":"10.1186","volume":"16","author":[{"given":"Tomoyuki","family":"Oyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsaku","family":"Nakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Miyao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Imazeki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaru","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"issue":"4","key":"580_CR1","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s10384-018-0600-y","volume":"62","author":"R Tanaka","year":"2018","unstructured":"Tanaka R, Kaburaki T, Ohtomo K, Takamoto M, Komae K, Numaga J, Fujino Y, Aihara M (2018) Clinical characteristics and ocular complications of patients with scleritis in Japanese. 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Written informed consent for publication was obtained from the patient. According to institutional policy, case reports are exempt from formal ethics committee approval at the National Defense Medical College Hospital.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent"}},{"value":"Written informed consent for publication was obtained from the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20"}}