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Background: The association between uveitis and spondyloarthropathy (SpA) related conditions is well-established. However, evidence describing the link between uveitis and psoriasis, and psoriasis without concomitant SpA-related-conditions is scarce and conflicting.
Objectives: This large-scale population-based study sought to describe the prevalence and features of uveitis among psoriasis patients in Israel as well as investigating the risk for uveitis in different subgroups of psoriasis patients compared to the general population.
Methods: We conducted a retrospective study utilizing the electronic database of the Meuhedet Health Maintenance Organization. The study included all patients diagnosed with psoriasis between 2000-2020, each patient was matched with four controls based on age, gender, place of residence, and index date. Logistic regression models were employed to assess the association between psoriasis and uveitis while adjusting for the presence of SpA-related conditions.
Results: 61,003 psoriasis patients and 244,012 matched-controls were included. The prevalence of uveitis was 1.3% vs. 1.1% respectively (OR=1.12; 95%CI 1.10-1.30; p<0.001). When adjusting to psoriasis severity, concurrent SpA, and psoriasis treatment no significant association was found. The rates of uveitis among psoriasis patients with concurrent SpA-related condition was 3.2% compared to 1.4% in controls without psoriasis or SpA (OR=2.38; 95%CI 2.00-2.83; p<0.001), while in psoriasis patients without SpA, rate of uveitis was 1.0% and was similar to controls. Although crude rates of uveitis were higher in patients with severe psoriasis compared to mild psoriasis (2.1% vs 1.1%), after adjustment no significant association compared to controls was found in either group.
Conclusion: Our findings suggest that the positive association between psoriasis and uveitis is primarily mediated by the coexistence of other SpA-related conditions. These findings imply to the presence of a shared pathogenetic mechanism and set the direction for a phenotypic-targeted screening strategy.
REFERENCES: [1] Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis. 2008 Jul;67(7):955–9.
[2] Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. Clin Rheumatol. 2015 Jun 28;34(6):999–1002.
[3] Egeberg A, Khalid U, Gislason GH, Mallbris L, Skov L, Hansen PR. Association of Psoriatic Disease With Uveitis: A Danish Nationwide Cohort Study. JAMA dermatology. 2015 Nov 1;151(11):1200–5.
Risk of uveitis in patients with psoriasis (compared to matched controls)
| Rates of uveitis in psoriasis, n/N(% ) | Rates of uveitis in controls, n/N(% ) | Crude OR (95% CI ) | Adjusted OR ¶ (95% CI ) | |
|---|---|---|---|---|
| All patients | 767/61,003 (1.3%) | 2,568/244,012 (1.1%) | 1.12 (1.10 to 1.30) ** | 1.04 (0.95 to 1.37) |
| Psoriasis Severity | ||||
| Mild psoriasis | 614/53,714
| 2,247/214,856
| 1.09 (1.00 to 1.12) | 1.02 (0.93 to 1.12) |
| Severe psoriasis | 153/7,289
| 321/29,156
| 1.93 (1.59 to 2.34) ** | 1.19 (0.93 to 1.54) |
| Severe psoriasis without PsA | 80/5,207
| 215/20,828
| 1.50 (1.15 to 1.94)* | 1.15 (0.88 to 1.51) |
| Psoriasis with SpA related diseases | ||||
| PsA | 64/1,845
| 98/7,380
| 2.67 (1.94 to 3.67) ** | 2.20 (1.56 to 3.09) ** |
| AS | 96/1,958
| 131/7,832
| 3.03 (2.32 to 3.96) ** | 1.94 (1.41 to 2.69) ** |
| IBD | 70/1,495
| 62/5,968
| 4.69 (3.31 to 6.63) ** | 3.03 (2.06 to 4.45) ** |
| Any | 208/6,446
| 356/25,784
| 2.38 (2.00 to 2.83) ** | 2.16 (1.80 to 2.58) ** |
| None | 559/54,557
| 2,212/218,228
| 1.01 (0.92 to 1.11) | 0.98 (0.89 to 1.08) |
| Treatments | ||||
| Treatment with biological agents | 80/5,207
| 215/20,828
| 1.49 (1.15 to 1.94) * | 1.15 (0.88 to 1.51) |
| Treatment with other agents (phototherapy, Methotrexate, topical) | 694/59,219
| 2,486/236,876
| 1.12 (1.03 to 1.22) | 1.01 (0.93 to 1.11) |
¶ Adjusted for age, sex, and uveitis related comorbidities.
* P-value< 0.05. ** P-value<0.001.
Abbreviations: AS, ankylosing spondylitis; IBD, inflammatory bowel disease; OR, odds ratio; PsA, psoriatic arthritis.
Acknowledgements: This work was supported by a grant from Janssen Pharmaceuticals, specifically designated for projects investigating morbidity in patients with psoriasis.
Disclosure of Interests: None declared.