Prevalence and factors associated with uveitis in spondylarthritis patients in France: Results from an observational survey

Canouï‐Poitrine, Florence; Lekpa, Fernando Kemta; Farrenq, Valérie; Boissinot, V.; Hacquard-Bouder, Cécile; Comet, D.; Bastuji‐Garin, Sylvie; Thibout, E.; Claudepierre, Pascal

doi:10.1002/acr.21616

Cited by 46 publications

(34 citation statements)

References 10 publications

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“…[8][9][10] Furthermore, no data exist on the risks for psoriasis or psoriatic arthritis in patients with uveitis. We therefore examined the risk for incident (new-onset) uveitis in patients with mild psoriasis, severe psoriasis, and psoriatic arthritis and for the reverse relationship in patients with uveitis in a nationwide cohort of the Danish population.…”

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confidence: 99%

Association of Psoriatic Disease With Uveitis

et al. 2015

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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.

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Association of Psoriatic Disease With Uveitis

et al. 2015

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“…Additionally, a recent French study evaluated the prevalence and the factors associated with uveitis in SpA patients in a nationwide cross-sectional study in which 202 participating rheumatologists recruited 902 patients (males 61 %), with a mean age of 45.3 ±13.4 years and a mean disease duration of 10.4 ± 9.6 years. Among these patients with SpA, 71 % had AS, 18 % had psoriatic arthritis, and 11 % had other types of SpA [18]. HLA-B27 was present in 76 % of the patients.…”

Section: Epidemiologymentioning

confidence: 97%

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

2015

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Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are HLA-B27 positive, should be questioned about inflammatory low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye inflammation responds well to corticosteroid and mydriatic eye drops and without the need for additional therapy. Use of oral corticosteroids is reserved for patients, especially with associated chronic inflammatory bowel disease or psoriatic arthritis presenting with bilateral, chronic, anterior, and/or intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel therapies, including the use of tumor necrosis factor blockers.

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“…1 recently conducted a survey of French rheumatologists to identify extra-articular manifestations in patients with spondyloarthritis (SpA). Dubbed EXTRA and reported in Arthritis Care & Research , 1 their survey identified 902 patients, 71% with ankylosing spondylitis (AS) and the rest with psoriatic arthritis or another form of SpA. They concluded that 32.2% of those in the survey had a history of uveitis, 1 a term used to describe intraocular inflammation, which is a topic that often lies outside of general rheumatology training.…”

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confidence: 99%

“…Dubbed EXTRA and reported in Arthritis Care & Research , 1 their survey identified 902 patients, 71% with ankylosing spondylitis (AS) and the rest with psoriatic arthritis or another form of SpA. They concluded that 32.2% of those in the survey had a history of uveitis, 1 a term used to describe intraocular inflammation, which is a topic that often lies outside of general rheumatology training. Indeed, uveitis was 44% more prevalent than psoriasis in this cohort, almost four times more frequently observed than clinically identified inflammatory bowel disease, and substantially more common than heart, lung, or genitourinary associations.…”

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confidence: 99%

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