Managing Psoriatic Arthritis With Inflammatory Bowel Disease and/or Uveitis

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory disease that presents with psoriasis (PsO), peripheral and axial arthropathy. The heterogeneity of disease presentation leads to the term “psoriatic disease (PsD)” which is thought to better encompass the range of clinical manifestations. PsA is associated with several comorbidities such as cardiovascular diseases, metabolic syndrome and other extra-articular manifestations including uveitis, and inflammatory bowel disease (IBD). While novel therapeutics are being developed following advances in our understanding of the pathogenesis of the disease, the diverse combinations of PsA with its various comorbidities still pose a clinical challenge in managing patients with PsA. This article reviews our current understanding of the pathogenesis of PsA and how various pathways in the pathogenesis lead to the two comorbid extra-articular manifestations – uveitis and IBD. We also review current evidence of treatment strategies in managing patients with PsA with comorbidities of uveitis and/or IBD.

Enthesitis in Bowel-Associated Dermatosis-Arthritis Syndrome in an Ulcerative Colitis Patient

“…Enthesitis is seen in various rheumatic diseases, mainly in spondyloarthropathy, especially with psoriatic arthritis (PsA). Coexistence of PsA and IBD, entities known to share some of the common genetic predisposition, may increase the risk of both disorders (HLA-B27, HLA-DRB1 ∗ 0103, and non-HLA polymorphisms) [ 10 ]. The goal of treatment is to achieve low or minimal disease activity in order to control the articular (e.g., enthesitis) and extraarticular manifestations (e.g., IBD).…”

Collaboration in the management of psoriasis and psoriatic arthritis: A survey of joint working in UK clinical practice

“…This collaboration may be useful in earlier diagnosis of relevant conditions and in therapy selection. Patients with psoriatic disease have an increased risk of IBD, which itself can present with dermatological and rheumatological manifestations 20 . Additionally, patients with psoriasis are at an increased risk of NAFLD, and therapeutic agents used in psoriatic disease commonly require hepatitis prescreening and regular liver function testing 6,21,22 .…”

“…Patients with psoriatic disease have an increased risk of IBD, which itself can present with dermatological and rheumatological manifestations. 20 Additionally, patients with psoriasis are at an increased risk of NAFLD, and therapeutic agents used in psoriatic disease commonly require hepatitis prescreening and regular liver function testing. 6,21,22 As such, collaborative working may encourage greater understanding about which patients should be referred for further liver disease investigations.…”

Data_Sheet_1.pdf

“…Biologics are widely used in treating moderate to severe psoriasis, psoriatic arthritis, rheumatoid arthritis, and hidradenitis suppurativa (1)(2)(3)(4). Systemic lupus erythematosus (SLE) induced by biologics mostly occurs during the treatment of psoriasis with tumor necrosis factor-alpha (TNFα) inhibitors, especially in patients with psoriatic and rheumatoid arthritis.…”