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The risk factors for uveitis among psoriatic arthritis patients: a population-based cohort study

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Abstract

Objective

To assess the frequency of uveitis in patients with psoriatic arthritis (PsA) in the era of biologics and to identify risk factors associated with uveitis.

Methods

A retrospective matched cohort study was conducted within the database of a large healthcare provider. Newly diagnosed 6147 adult PsA patients between 2005 and 2020 were matched by the index date of PsA diagnosis, age, sex, and ethnicity to 23,999 randomly selected controls. This cohort was used to examine the association between PsA and uveitis. An additional analysis was conducted within the PsA group to identify uveitis risk factors, using two analytic approaches: a retrospective cohort study and a nested case-control study.

Results

Uveitis was diagnosed in 107 patients in the PsA group (1.7%) vs 187 (0.8%) patients in the control group (adjusted HR, 2.38, 95% CI 1.80–3.15, p<0.005) and was similar when the analysis was confined to patients without past uveitis. Uveitis was diagnosed more in females (2.1% vs 1.3%, HR 1.61, 95% CI 1.09–2.40, p<0.05), and was acute in all cases. Anterior uveitis was documented in 41.1% of the cases, 64.5% unilateral, and 9.3% bilateral. In the PsA group, using nested case control approach, only past uveitis [adjusted OR 136.4 (95% CI 27.38–679.88), p<0.005] and treatment with etanercept [adjusted OR 2.57 (95% CI 1.45–4.57), p=0.001] were independently associated with uveitis. Only one PsA patient with uveitis (out of 107) required systemic oral treatment with prednisone, while the rest of the patients were treated with topical glucocorticosteroids only.

Conclusion

PsA is associated with increased risk of uveitis. Past uveitis and treatment with etanercept were associated with higher risk of uveitis.

Key Points

• Psoriatic arthritis (PsA) is a major risk factor for uveitis with hazard ratio of 2.38 compared to healthy individuals without PsA.

• Among PsA patients, the past event of uveitis and treatment with etanercept are risk factors for uveitis.

• Uveitis in patients treated with biologics for their PsA requires topical therapy only in most of the cases.

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Acknowledgements

This research paper pays tribute to the memory of Mrs. I. Lavi whom we would like to acknowledge and appreciate her invaluable contributions to this research.

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Author notes

  1. Walid Saliba and Devy Zisman contributed equally to the manuscript.

Authors and Affiliations

  1. Department of medicine A and Rheumatology Unit, Carmel Medical Center, Michal 7 St., 3436212, Haifa, Israel

    Nizar Hijazi

  2. Rheumatology Unit, Carmel Medical Center, Haifa, Israel

    Tal Gazitt, Amir Haddad, Muna Elias & Devy Zisman

  3. Division of Rheumatology, University of Washington Medical Center, Seattle, USA

    Tal Gazitt

  4. Department of medicine A, Carmel Medical Center, Haifa, Israel

    Sameer Kassem

  5. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Sameer Kassem & Devy Zisman

  6. Chief Physician’s Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel

    Ilan Feldhamer & Arnon Dov Cohen

  7. Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Arnon Dov Cohen

  8. Opthalmology department, Carmel Medical Center, Haifa, Israel

    Shaul Sar & Oren Tomkins-Netzer

  9. Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel

    Walid Saliba

Authors
  1. Nizar Hijazi
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  10. Walid Saliba
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  11. Devy Zisman
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Corresponding author

Correspondence to Nizar Hijazi.

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Ethics approval

This study was performed in accordance with the principles of the Declaration of Helsinki and was approved by the research ethics committee (institutional review board) of Carmel Medical Center (CMC-0014-14).

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Requirement for individual patient consent forms was waived due to the retrospective, observational nature of the study.

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All authors reviewed the manuscript, helped in editing it, and approved its publication.

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Hijazi, ., Gazitt, T., Haddad, A. et al. The risk factors for uveitis among psoriatic arthritis patients: a population-based cohort study. Clin Rheumatol 43, 1053–1061 (2024). https://doi.org/10.1007/s10067-023-06834-y

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  • DOI: https://doi.org/10.1007/s10067-023-06834-y

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