Uveitis and Psoriasis

We are all aware of the association of psoriasis with systemic comorbidities. Psoriasis, psoriatic arthritis (PsA), and uveitis are inflammatory disorders that have notable overlap in their inflammatory pathways. In an article published online on July 29 in JAMA Dermatology, Egeberg et al investigated the potential bidirectional relationship between psoriatic disease and uveitis.

The researchers conducted a study (1997-2011) of 74,129 patients aged 18 years and older with incident psoriasis who were identified through administrative registries. There also were 13,114 patients with uveitis identified from the study cohort.

Incidence rates for uveitis per 10,000 person-years were 2.02 (95% CI [confidence interval], 1.99-2.06) for the reference population, 2.88 (95% CI, 2.33-3.56) for patients with mild psoriasis, 4.23 (2.40-7.45) for severe psoriasis, and 5.49 (95% CI, 3.36-8.96) for PsA. Incidence rate ratios per 10,000 person-years for the reference population, which included participants without uveitis, were 9.37 (95% CI, 9.30-9.45) for patients with mild psoriasis, 1.12 (95% CI, 1.10-1.15) for severe psoriasis, and 1.04 (95% CI, 1.01-1.06) for PsA. Patients with uveitis had corresponding incidence rates of 15.51 (95% CI, 12.92-18.62) for mild psoriasis, 2.66 (95% CI, 1.72-4.13) for severe psoriasis, and 4.25 (95% CI, 3.00-6.01) for PsA. Incidence rate ratios per 10,000 person-years for patients with uveitis were 1.59 (95% CI, 1.32-1.91) for mild psoriasis, 2.17 (95% CI, 1.40-3.38) for severe psoriasis, and 3.77 (95% CI, 2.66-5.34) for PsA.

The authors concluded that there is a bidirectional association between psoriatic disease and uveitis. They noted that increased focus on ocular symptoms in patients with psoriasis and PsA and on cutaneous and joint symptoms in patients with prior or current uveitis may be appropriate.

What’s the issue?

This research adds to the potential comorbidities of psoriasis and also adds a potential comorbidity of uveitis itself. Therefore, it would be helpful to add ocular symptoms to our review of systems in those with psoriatic disease. How will this information affect your workup of psoriasis patients?

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