Analysis Finds Elevated Risk of Psoriasis, Psoriatic Arthritis in Patients With Uveitis

Patients with uveitis may be at greater risk for psoriatic arthritis (PsA) and a severe psoriasis disease course, according to study findings published this week in PLoS One.

As an intraocular inflammatory disease, uveitis was noted by researchers to share a similar pathogenesis to that of psoriasis, a condition also characterized by inflammation and immune reactions.

In prior research investigating the link between the 2 conditions, conflicting findings have shown an inverse risk of uveitis in patients with psoriasis, with uveitis also independently associated with psoriasis severity.

As one of the first studies to assess the risk of subsequent psoriasis and psoriatic arthritis development in an Asian cohort of patients with uveitis, researchers conducted a nationwide population-based cohort study of individuals registered in Taiwan’s national health insurance research database.

“Very few studies have been conducted with a cohort, directional approach from uveitis to psoriasis, and most of the studies to date have been performed in Western countries,” noted the study authors.

In the study, data were collected from 195,125 patients with new-onset uveitis between 2001 and 2013 and compared with 390,250 randomly selected people of the general population matched for age, sex, and year of enrollment at a 1:2 ratio. The mean (SD) age of the overall study cohort was 50.2 (17.2) years.

Risk of psoriasis or psoriatic arthritis corresponding to uveitis was assessed via multivariate Cox regression analysis, with separate subgroup analyses conducted to examine risk for mild psoriasis, severe psoriasis, and psoriatic arthritis, and by uveitis type (anterior, intermediate, posterior, panuveitis).

Notably, comorbidities known to correlate positively with psoriasis severity, including hypertension, diabetes, hyperlipidemia, and obesity, were found to be more prevalent in the uveitis group (all P < .0001).

After adjusting for age, sex, insurance cost, and comorbidities, patients with uveitis were shown to be 41% more likely to develop psoriasis or psoriatic arthritis than the general population (adjusted HR [aHR], 1.41; 95% CI, 1.33-1.48; P < .0001). All types of uveitis were significantly associated with a greater risk of psoriasis or psoriatic arthritis development.

Moreover, an increasing trend in risk was observed by severity from mild psoriasis (aHR, 1.35; 95% CI, 1.28-1.44) to severe psoriasis (aHR, 1.59; 95% CI, 1.30-1.94), with risk of psoriatic arthritis also significant in patients with uveitis (aHR, 1.97; 95% CI, 1.60-2.42).

“Ophthalmologists should be alert to the development of psoriatic lesions when managing patients with uveitis. Rheumatologists and dermatologists should also be alert for symptoms of uveitis, which may be early indicators of psoriatic arthritis,” concluded the study authors. “The use of a referral system and close cooperation among ophthalmologists, rheumatologists, and dermatologists are important to manage these patients.”

Reference

Chen YY, Chen HH, Lo TC, Chou P. The risk of psoriasis in patients with uveitis: a nationwide population-based cohort study. PLoS One. Published online August 2, 2021. doi:10.1371/journal.pone.0255492