Risk of Uveitis Among People With Psoriasis

Abstract

soriasis is a chronic inflammatory dermatosis that affects 0.1% to 3% of the adult population worldwide and results in a heavy economic burden. [1][2][3][4][5][6] Psoriasis has been associated with various comorbidities, including cardiovascular disease, stroke, diabetes mellitus, renal diseases, and arthritis. 7,8 Various studies reported that 6% to 42% of participants with psoriasis had concomitant psoriatic arthritis, while the percentage was lower among Asian people. 9 Psoriatic arthritis is an inflammatory joint disease that may lead to joint destruction and disability. 9 Uveitis is characterized by inflammation involving the uveal tract and associated ocular structures including the iris, ciliary body, and choroid tissue. 10 When affecting the anterior chamber, uveitis may present with pain and redness of the eye. When affecting the posterior chamber, eye pain and redness may not appear, but compromised visual acuity may occur. 11 Uveitis has been associated with psoriatic arthritis 12 and was more frequent and severe in the presence of human leukocyte antigen B27. 13 By contrast, the relationship between uveitis and psoriasis is still under investigation. 11 There have been a few studies examining the association between uveitis and psoriasis without psoriatic arthritis. A US case series reported that 9 patients with psoriasis without psoriatic arthritis had uveitis. 14 A cross-sectional study of 100 Singaporean patients with psoriasis found that the severity of psoriasis assessed by the Global Assessment score of the Lattice System Physician appeared to be higher among patients with uveitis than those without uveitis, although the difference did not reach statistical significance. 15 However, the Singaporean study did not find an association between uveitis and psoriatic arthritis. 15 A Turkish case-control study among 100 patients IMPORTANCE Uveitis has been associated with psoriatic arthritis, but to our knowledge, the relationship between uveitis and psoriasis is unsettled among researchers. OBJECTIVE To evaluate the risk of incident uveitis among people with psoriasis. DESIGN, SETTING, AND PARTICIPANTS This nationwide, retrospective cohort study conducted in Taiwan from January 1, 2000, to December 31, 2012 included 147 954 people with psoriasis (including 10 107 with concomitant psoriatic arthritis and 137 847 without psoriatic arthritis) and 147 954 nonpsoriatic controls. EXPOSURE Psoriasis. MAIN OUTCOMES AND MEASURES Risk of incident uveitis. RESULTSThe mean (SD) age of the 295 908 study participants was 44.4 (19.8) years, and 41.2% (n = 121 878) were women. We found that the group with severe psoriasis with psoriatic arthritis had the greatest risk of incident uveitis compared with the nonpsoriatic controls (adjusted hazard ratio, 2.40; 95% CI, 1.90-3.02). The group with severe psoriasis without psoriatic arthritis and the group with mild psoriasis with psoriatic arthritis also had an increased risk of incident uveitis (adjusted hazard ratio, 1.42; 95% CI, 1.23-1.64; and 1.42; 95% CI, 1.03-1.96; r...

Functionally distinct ERAP1 and ERAP2 are a hallmark of HLA-A29-(Birdshot) Uveitis

“…Hap1/Hap2 are risk haplotypes for AS and psoriasis [8,12], while being protective for BD and Birdshot. Therefore, Hap10 and Hap2 of ERAP1 play a central role for patients within the MHC-I-opathy cluster: patients with psoriasis have an increased risk of uveitis [31]. Patients with AS and BD often have uveitis [11,42], and the ERAP1 associations are much stronger in cases that developed uveitis compared with cases with systemic disease alone [2,32].…”

Effect of Uveitis on the Development of Keratopathy: A Population-Based Cohort Study

“…In clinical studies, systemic disorders featuring immune and inflammation impairment, such as rheumatoid arthritis and psoriasis, were associated with the occurrence of uveitis and keratopathies. 9,11,12,27 Additionally, the concomitant uveitis and keratitis in patients with rheumatoid arthritis had been reported. 28 The above evidence suggests a more universal risk of keratopathies in patients with uveitis resulting from the uveitis itself or a diffuse inflammatory reaction, which was proved by the current study.…”

“…10 Other morbidities that are associated with uveitis include Behçet disease, syphilis, seronegative spondyloarthropathies, and psoriasis. 9,11 In general, all of the above diseases and uveitis share a similar pathophysiology of inflammation, which implies that uveitis and related inflammatory reactions may also damage the ocular tissue. 12 Concerning uveitis and associated ocular diseases, glaucoma, and cataracts have been proven to be associated with anterior uveitis.…”

Drug survival of biologics in treating psoriasis: a meta-analysis of real-world evidence

“…Psoriasis is a chronic inflammatory dermatosis 1 , 2 . Biologics are indicated for treating moderate to severe psoriasis that is unresponsive to conventional systemic therapies or phototherapy or when the patients are intolerant to traditional treatments 3 , 4 .…”