How would you approach persistent episcleritis/uveitis due to PR3+ GPA, which needs low dose prednisone to control, despite induction with Rituximab?

In patients who have refractory inflammatory eye disease despite rituximab, I have worked with ophthalmology to determine whether baseline escalation in immunosuppressive medication is indicated or if targeted organ therapy is an option. In general, there is more urgency when there is chronic active uveitis compared to episcleritis. In some cases ophtho can perform intraocular steroid injections which will decrease dependency on oral or topical steroid drops. In other cases, I have added DMARDs ...