Association of Psoriatic Disease With Uveitis

Abstract

IMPORTANCE Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. Limited evidence is available about the relationship between psoriatic disease and uveitis.OBJECTIVE To investigate the potential bidirectional relationship between psoriatic disease, including psoriasis and psoriatic arthritis, and uveitis. DESIGN, SETTING, AND PARTICIPANTSWe performed a nationwide cohort study of the Danish population from January 1, 1997, through December 31, 2011. We included 74 129 Danish patients with psoriasis who were 18 years or older during the study period. Patients were identified through administrative registries, and information on age, sex, socioeconomic status, medication, and comorbidity was obtained using individual-level linkage of administrative registers. We performed data analysis from January 27 through March 4, 2015.EXPOSURES Diagnosis of mild or severe psoriasis or psoriatic arthritis for uveitis risk and diagnosis of uveitis for the risk for psoriasis or psoriatic arthritis.MAIN OUTCOMES AND MEASURES Diagnosis of uveitis, mild psoriasis, severe psoriasis, or psoriatic arthritis. We calculated incidence rates (IRs) and estimated IR ratios adjusted for potential confounders using Poisson regression. RESULTSWe identified 74 129 cases of psoriasis and psoriatic arthritis and 13 114 cases of uveitis. The IRs (95% CIs) for uveitis were 2.02 (1.99-2.06), 2.88 (2.33-3.56), 4.23 (2.40-7.45), and 5.49 (3.36-8.96) for the reference population and those with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. In the reference population, these IRs (95% CIs) were 9.37 (9.30-9.45), 1.12 (1.10-1.15), and 1.04 (1.01-1.06), and in patients with uveitis, these statistics were 15.51 (12.92-18.62), 2.66 (1.72-4.13), and 4.25 (3.00-6.01) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Adjusted IR ratios (95% CIs) for uveitis were 1.38 (1.11-1.70 [P = .02]), 1.40 (0.70-2.81 [P = .34]), and 2.50 (1.53-4.08 [P < .001]) for patients with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. For patients with uveitis, IR ratios (95% CIs) were 1.59 (1.32-1.91 [P < .001]) for mild psoriasis, 2.17 (1.40-3.38 [P < .001]) for severe psoriasis, and 3.77 (2.66-5.34 [P < .001]) for psoriatic arthritis, respectively. CONCLUSIONS AND RELEVANCEWe found a bidirectional association between psoriatic disease and uveitis. Increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with prior or current uveitis may be appropriate.

Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis: a population-based cohort study

“…Recent Danish and Taiwanese nationwide cohort studies, using administrative data, have reported an increased risk of uveitis associated with psoriatic disease 5 6. The Danish study demonstrated a bidirectional association, with patients with psoriasis and PsA having an increased risk of uveitis and patients with uveitis having an increased risk of psoriasis and PsA, suggesting a shared pathogenic pathway 5. Another study, using the same Danish data source, has reported an increased risk of Crohn’s disease and ulcerative colitis among patients with psoriasis and PsA,7 as have two studies using data from US Health Claims databases,8 9 and one looking at PsA using data from an Israeli healthcare database 10.…”

Evidence-based algorithm for diagnosis and assessment in psoriatic arthritis: results by Italian DElphi in psoriatic Arthritis (IDEA)

“…Furthermore, the case of patients with arthritis and familiar psoriasis provides a PsA subset classified as sine psoriasis (8). In addition, in recent years the increase of clinical studies have outlined how PsA can be associated with extrarticular manifestations, also alternatively recognized as comorbities (9)(10)(11)(12)(13). Among these, the most frequent are represented by uveitis (9), colitis (10), metabolic syndrome (MS) (11) and involvement of the cardiovascular system (12).…”

“…In addition, in recent years the increase of clinical studies have outlined how PsA can be associated with extrarticular manifestations, also alternatively recognized as comorbities (9)(10)(11)(12)(13). Among these, the most frequent are represented by uveitis (9), colitis (10), metabolic syndrome (MS) (11) and involvement of the cardiovascular system (12). Psychological aspects, such as depressive symptoms and anxiety, represent important correlates of health related quality of life (HRQoL) (13).…”

Successful ustekinumab treatment of noninfectious uveitis and concomitant severe psoriatic arthritis and plaque psoriasis

“…Autoimmune diseases that are more often associated with uveitis include rheumatoid arthritis and Behçet's disease, but other conditions are also prone to uveitis development, with significant overlap in their inflammatory pathways, including psoriasis and psoriatic arthritis (PsA) (Egeberg et al, 2015).…”

“…FIG URE 1 Severe plaque type psoriasis (PASI 22), before starting ustekinumab treatment FIG URE 2 Complete psoriasis remission at Week 163 | DI SCUS SIONPopulation studies have recently confirmed a bidirectional association between uveitis and various forms of psoriasis and psoriatic arthritis, suggesting a prompt ophthalmologist examination to detect ocular comorbidity as well as appropriate skin and joint evaluation in patients with uveitis(Egeberg et al, 2015; Yang et al, 2016). She had been treated by a rheumatologist and given 3.0 mg/kg per day cyclosporine A, with some improvement of the ocular manifestations, until a sudden worsening of both psoriasis (Psoriasis Area Severity Index, PASI: 12.7) and uveitis (UV) occurred in March 2015, with severe visual impairment.…”