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Psoriasis and uveitis

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Abstract

Purpose

Psoriasis, which is a chronic, immune-mediated skin disease of unknown etiology, not only affects the skin, but also is linked to many systemic conditions such as arthritis, cardiovascular disease, depression, and malignancy. Although many types of eye involvement are encountered in psoriasis patients, dry eye is the first among them. Uveitis is an entity that can be associated with psoriasis and can cause severe vision loss as a result of late diagnosis, inadequate and inappropriate treatment. In this review, we aimed to shed light on the diagnosis, type, prognosis and treatment of uveitis in psoriasis patients by compiling current datas obtained from published studies and to guide the follow-up and treatment of these patients.

Methods

A systematic literature search was done on PubMed using key words including “psoriasis”, “psoriatic arthritis”, “uveitis”, “TNF- inhibitors”, “HLA B27”.

Results

In the literature, the frequency, type and treatment of uveitis developing in the course of psoriatic arthritis are clearly defined. However, the coexistence of psoriasis and uveitis has not yet been clarified due to few numbers published studies and designs of these studies. Since we examined the existing studies, we determined that the coexistence of psoriasis and uveitis could be acute or insidious, and the probability and severity of uveitis increased as the severity of skin and joint involvement increased. In addition, we found that psoriasis-associated uveitis can be bilateral, chronic, severe progression and with a high recurrence rate.

Conclusion

The relations between non-arthritic psoriasis and uveitis have not yet been fully elucidated. Physicians who treat these diseases must be cautious, and refer their patients who have psoriasis to an ophthalmologist for periodic examination, even if they do not have eye symptoms. On the other hand, ophthalmologists must be careful in uveitis patients in terms of skin and joint involvement, and must not overlook the underlying disease.

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References

  1. Rajguru J, Maya D, Kumar D, Suri P, Bhardwaj S, Patel N (2020) Update on psoriasis: a review. J Fam Med Prim Care 9(1):20

    Article  Google Scholar 

  2. Frank Nestle PO, Kaplan DH, Barker J (2009) Psoriasis-mechanisms of disease. N Engl J Med 361:496–509

    Article  PubMed  Google Scholar 

  3. Lam M, Steen J, Di LuJ, Vender R (2020) The incidence and prevalence of uveitis in psoriasis: a systematic review and meta-analysis. J Cutan Med Surg 24(6):601–607

    Article  PubMed  Google Scholar 

  4. Fotiadou C, Lazaridou E (2019) Psoriasis and uveitis: links and risks. Psoriasis Targets Ther 9:91–96

    Article  CAS  Google Scholar 

  5. Rendon A, Schäkel K (2019) Psoriasis pathogenesis and treatment. Int J Mol Sci 20(6):1475

    Article  CAS  PubMed Central  Google Scholar 

  6. Demerdjieva Z, Mazhdrakova I, Tsankov N (2019) Ocular changes in patients with psoriasis. Clin Dermatol 37(6):663–667

    Article  PubMed  Google Scholar 

  7. Kilic B, Dogan U, Parlak AH, Goksugur N, Polat M, Serin D et al (2013) Ocular findings in patients with psoriasis. Int J Dermatol 52(5):554–559

    Article  PubMed  Google Scholar 

  8. Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN et al (2019) Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 80(4):1073–1113

    Article  PubMed  Google Scholar 

  9. Campanati A, Neri P, Giuliodori K, Arapi I, Carbonari G, Borioni E et al (2015) Psoriasis beyond the skin surface: a pilot study on the ocular involvement. Int Ophthalmol 35(3):331–340

    Article  CAS  PubMed  Google Scholar 

  10. Okamoto F, Umebayasi Y, Ohtsuka F, Hommura S (2001) Factors associated with increased aqueous flare in psoriasis. Jpn J Ophthalmol 45(2):172–176

    Article  CAS  PubMed  Google Scholar 

  11. Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI (2011) Ocular psoriasis. J Am Acad Dermatol 65(6):1202–1212

    Article  PubMed  Google Scholar 

  12. Huynh N, Cervantes-Castaneda RA, Bhat P, Gallagher MJ, Foster CS (2008) Biologic response modifier therapy for psoriatic ocular inflammatory disease. Ocul Immunol Inflamm 16(3):89–93

    Article  CAS  PubMed  Google Scholar 

  13. Cordero-Coma M, Anzaar F, Sobrin L, Foster CS (2007) Systemic immunomodulatory therapy in severe dry eye secondary to inflammation. Ocul Immunol Inflamm 15(2):99–104

    Article  CAS  PubMed  Google Scholar 

  14. Krueger G, Koo J, Lebwohl M et al (2001) The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol 137(3):280–284

    CAS  PubMed  Google Scholar 

  15. Erbagci I, Erbagci Z, Gungor K, Bekir N (2003) Ocular anterior segment pathologies and tear film changes in patients with psoriasis vulgaris. Acta Med Okayama 57(6):299–303

    PubMed  Google Scholar 

  16. Ajitsaria R, Dale R, Ferguson V, Mayou S, Cavanagh N (2001) Psoriasis, psoriatic arthropathy and relapsing orbital myositis. Clin Exp Dermatol 26(3):274–275

    Article  CAS  PubMed  Google Scholar 

  17. Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C et al (2018) A focus on the epidemiology of uveitis. Ocul Immunol Inflamm 26(1):2–16

    Article  PubMed  Google Scholar 

  18. Durrani K, Foster CS (2005) Psoriatic uveitis: A distinct clinical entity? Am J Ophthalmol 139(1):106–111

    Article  PubMed  Google Scholar 

  19. Parisi R, Symmons DPM, Griffiths CEM, Ashcroft DM (2021) Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 133(2):377–385

    Article  CAS  Google Scholar 

  20. Puig L (2017) Paradoxical reactions: anti-tumor necrosis factor alpha agents, ustekinumab, secukinumab, ixekizumab, and others. Curr Probl Dermatol 53:49–63

    Article  PubMed  Google Scholar 

  21. Niccoli L, Nannini C, Cassarà E, Kaloudi O, Susini M, Lenzetti I et al (2012) Frequency of iridocyclitis in patients with early psoriatic arthritis: a prospective, follow up study. Int J Rheum Dis 15(4):414–418

    Article  PubMed  Google Scholar 

  22. Chandran NS, Greaves M, Gao F, Lim L, Cheng BCL (2007) Psoriasis and the eye: prevalence of eye disease in Singaporean Asian patients with psoriasis. J Dermatol 34(12):805–810

    Article  PubMed  Google Scholar 

  23. Fraga NAA, Oliveira MPF, Follador I et al (2012) Psoriasis and uveitis: a literature review. An Bras Dermatol 87(6):877–883

    Article  PubMed  PubMed Central  Google Scholar 

  24. Paiva ES, Macaluso DC, Edwards A, Rosenbaum JT (2000) Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis 59(1):67–70

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Iijima S, Iwata M, Otsuka F (1996) Psoriatic arthritis and hypopyon-lridocyclitis. Dermatology 193(4):295–299

    Article  CAS  PubMed  Google Scholar 

  26. Queiro R, Torre JC, Belzunegui J, González C, De Dios JR, Unanue F et al (2002) Clinical features and predictive factors in psoriatic arthritis-related uveitis. Semin Arthritis Rheum 31(4):264–270

    Article  PubMed  Google Scholar 

  27. Chaiyabutr C, Ungprasert P, Silpa-Archa N, Wongpraparut C, Chularojanamontri L (2020) Psoriasis and risk of uveitis: a systematic review and meta-analysis. Biomed Res Int 15(2020):9308341

    Google Scholar 

  28. Sharma SM, Jackson D (2017) Uveitis and spondyloarthropathies. Best Pract Res Clin Rheumatol 31(6):846–862

    Article  PubMed  Google Scholar 

  29. Tanaka R, Takamoto M, Komae K, Ohtomo K, Fujino Y, Kaburaki T (2015) Clinical features of psoriatic uveitis in Japanese patients. Graefe’s Arch Clin Exp Ophthalmol 253(7):1175–1180

    Article  Google Scholar 

  30. Yang P, Zheng M, Zhang L, Du L, Zhou Q, Cai T et al (2017) Uveitis in Chinese patients with psoriasis. Ocul Immunol Inflamm 25(6):855–865

    Article  PubMed  Google Scholar 

  31. Chi CC, Tung TH, Wang J, Lin YS, Chen YF, Hsu TK et al (2017) Risk of uveitis among people with psoriasis: a nationwide cohort study. JAMA Ophthalmol 135(5):415–422

    Article  PubMed  PubMed Central  Google Scholar 

  32. Egeberg A, Khalid U, Gislason GH, Mallbris L, Skov L, Hansen PR (2015) Association of psoriatic disease with Uveitis: a danish nationwide cohort study. JAMA Dermatol 151(11):1200–1205

    Article  PubMed  Google Scholar 

  33. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB et al (2008) Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 58(5):826–850

    Article  PubMed  Google Scholar 

  34. Radtke MA, Schäfer I, Glaeske G, Jacobi A, Augustin M (2017) Prevalence and comorbidities in adults with psoriasis compared to atopic eczema. J Eur Acad Dermatol Venereol 31(1):151–157

    Article  CAS  PubMed  Google Scholar 

  35. Türkcü FM, Şahin A, Yüksel H, Akkurt M, Uçmak D, Çınar Y et al (2016) Evaluation of choroidal thickness in psoriasis using optical coherence tomography. Int Ophthalmol 36(6):851–854

    Article  PubMed  Google Scholar 

  36. Chowdhury B, Pavaiya A, Khurana VK (2017) Ocular findings in psoriasis patients. Int J Contemporary Med Res 4(10):2075–2078

    Google Scholar 

  37. Weinstein JE, Pepple KL (2018) Cytokines in uveitis. Current opinion in ophthalmology. Curr Opin Ophthalmol 29(3):267–274

    Article  PubMed  PubMed Central  Google Scholar 

  38. Zhang J, Lin Y, Li C, Zhang X, Cheng L, Dai L et al (2016) IL-35 Decelerates the inflammatory process by regulating inflammatory cytokine secretion and M1/M2 macrophage ratio in psoriasis. J Immunol 197(6):2131–2144

    Article  CAS  PubMed  Google Scholar 

  39. Ruiz de Morales JMG, Puig L, Daudén E, Cañete JD, Pablos JL, Martín AO et al (2020) Critical role of interleukin (IL)-17 in inflammatory and immune disorders: an updated review of the evidence focusing in controversies. Autoimmun Rev 19(1):102429

    Article  CAS  PubMed  Google Scholar 

  40. El-Asrar AMA, Struyf S, Kangave D, Al-Obeidan SS, Opdenakker G, Geboes K et al (2011) Cytokine profiles in aqueous humor of patients with different clinical entities of endogenous uveitis. Clin Immunol 139(2):177–184

    Article  CAS  PubMed  Google Scholar 

  41. Jawad S, Liu B, Agron E, Nussenblatt RB, Sen HN (2013) Elevated serum levels of interleukin-17A in uveitis patients. Ocul Immunol Inflamm 21(6):434–439

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Pepple KL, Lin P (2018) Targeting Interleukin-23 in the treatment of noninfectious uveitis. Ophthalmology 125(12):1977–1983

    Article  PubMed  Google Scholar 

  43. Velez G, Nathaniel Roybal C, Colgan D, Tsang SH, Bassuk AG, Mahajan VB (2016) Personalized proteomics for the diagnosis and treatment of idiopathic inflammatory disease. JAMA Ophthalmol 134(4):444–448

    Article  PubMed  PubMed Central  Google Scholar 

  44. Chi W, Zhu X, Yang P, Liu X, Lin X, Zhou H et al (2008) Upregulated IL-23 and IL-17 in Behçet patients with active uveitis. Investig Ophthalmol Vis Sci 49(7):3058–3064

    Article  Google Scholar 

  45. Jiang S, Liu X, Luo L, Qu B, Huang X, Xu L et al (2010) Elevated serum IL-23 correlates with intraocular inflammation after cataract surgery in patients with Vogt-Koyanagi-Harada disease. Br J Ophthalmol 94(8):1078–1082

    Article  PubMed  Google Scholar 

  46. Chen W, Zhao B, Jiang R, Zhang R, Wang Y, Wu H et al (2015) Cytokine expression profile in aqueous humor and sera of patients with acute anterior uveitis. Curr Mol Med 15(6):543–549

    Article  CAS  PubMed  Google Scholar 

  47. Ooi KGJ, Galatowicz G, Calder VL, Lightman SL (2006) Cytokines and chemokines in uveitis - Is there a correlation with clinical phenotype. Clin Med Res 4(4):294–309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Di Cesare A, Di Meglio P, Nestle FO (2009) The IL-23Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol 129(6):1339–1350

    Article  PubMed  CAS  Google Scholar 

  49. Keino H, Sakai JI, Usui M (2003) Association between HLA-A2 in Japanese psoriasis arthritis and susceptibility to uveitis. Graefes Arch Clin Exp Ophthalmol 241(9):777–778

    Article  PubMed  Google Scholar 

  50. Maejima H, Watarai A, Nakano T, Katayama C, Nishiyama H, Katsuoka K (2014) Adverse effects of methotrexate in three psoriatic arthritis patients. Rheumatol Int 34(4):571–574

    Article  CAS  PubMed  Google Scholar 

  51. Wendling D, Prati C (2014) Paradoxical effects of anti-TNF-α agents in inflammatory diseases. Exp Rev Clin Immunol 10(1):159–169

    Article  CAS  Google Scholar 

  52. Sheppard J, Joshi A, Betts KA, Hudgens S, Tari S, Chen N et al (2017) Effect of adalimumab on visual functioning in patients with noninfectious intermediate uveitis, posterior uveitis, and panuveitis in the VISUAL-1 and VISUAL-2 Trials. JAMA Ophthalmol 135(6):511–518

    Article  PubMed  PubMed Central  Google Scholar 

  53. Power WJ, Rodriguez A, Pedroza-Seres M, Foster CS (1998) Outcomes in anterior uveitis associated with the HLA-B27 haplotype. Ophthalmology 105(9):1646–1651

    Article  CAS  PubMed  Google Scholar 

  54. Melón JF, Fernández SM, Hidalgo V (2004) Uveitis as the initial clinical manifestation in patients with spondyloarthropathies. J Rheumatol 31(3):524–527

    Google Scholar 

  55. Abbouda A, Abicca I, Fabiani C, Scappatura N, Peña-García P, Scrivo R et al (2017) Psoriasis and psoriatic arthritis-related uveitis: different ophthalmological manifestations and ocular inflammation features. Semin Ophthalmol 32(6):715–720

    Article  PubMed  Google Scholar 

  56. Lee Y, Oh BL, Yu HG, Youn SW, Woo SJ (2021) Clinical characteristics of uveitis in patients with psoriasis in korea: a retrospective multicenter case series. Korean J Ophthalmol 35(1):64–72

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Burden-Teh E, Murphy R (2014) Psoriasis and uveitis - Should we be asking about eye symptoms? Br J Dermatol 170(3):756–757

    Article  CAS  PubMed  Google Scholar 

  58. Brüner M, Dige A, Loft AG, Laurberg TB, Agnholt JS, Clemmensen K et al (2021) Spondylitis-psoriasis-enthesitis-enterocolitis-dactylitis-uveitis-peripheral synovitis (SPEED-UP) treatment. Autoimmun Rev 20(2):102731

    Article  PubMed  CAS  Google Scholar 

  59. So A, Inman RD (2018) An overview of biologic disease-modifying antirheumatic drugs in axial spondyloarthritis and psoriatic arthritis. Best Pract Res Clin Rheumatol 32(3):453–471

    Article  PubMed  Google Scholar 

  60. Rudwaleit M, Rosenbaum JT, Landewé R, Marzo-Ortega H, Sieper J, Van Der Heijde D et al (2016) Observed incidence of uveitis following certolizumab pegol treatment in patients with axial spondyloarthritis. Arthritis Care Res 68(6):838–844

    Article  CAS  Google Scholar 

  61. Kavanaugh A, Mclnnes I, Mease P, Krueger GG, Gladman D, Gomez-Reino J et al (2009) Golimumab, a new human tumor necrosis factor α antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: twenty-four-week efficacy and safety results of a randomized, placebo-controlled study. Arthritis Rheum 60(4):976–986

    Article  CAS  PubMed  Google Scholar 

  62. van Bentum RE, Heslinga SC, Nurmohamed MT, Gerards AH, Griep EN, Koehorst CBJM et al (2019) Reduced occurrence rate of acute anterior uveitis in ankylosing spondylitis treated with golimumab - The go-easy study. J Rheumatol 46(2):153–159

    Article  PubMed  CAS  Google Scholar 

  63. Mugheddu C, Atzori L, Del Piano M, Lappi A, Pau M, Murgia S et al (2017) Successful ustekinumab treatment of noninfectious uveitis and concomitant severe psoriatic arthritis and plaque psoriasis. Dermatol Ther 30(5):e12527

    Article  Google Scholar 

  64. Dick AD, Tugal-Tutkun I, Foster S, Zierhut M, Melissa Liew SH, Bezlyak V et al (2013) Secukinumab in the treatment of noninfectious uveitis: results of three randomized, controlled clinical trials. Ophthalmology 120(4):777–787

    Article  PubMed  Google Scholar 

  65. Letko E, Yeh S, Stephen Foster C, Pleyer U, Brigell M, Grosskreutz CL (2015) Efficacy and safety of intravenous secukinumab in noninfectious uveitis requiring steroid-sparing immunosuppressive therapy. Ophthalmology 122(5):939–948

    Article  PubMed  Google Scholar 

  66. Lu J, Tang S, Yu N, Yi X, Li Y (2020) Successful secukinumab treatment of erythrodermic psoriasis and psoriatic arthritis concomitant with severe noninfectious uveitis: a case report. J Int Med Res. 48(11)

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Köse, B., Uzlu, D. & Erdöl, H. Psoriasis and uveitis. Int Ophthalmol 42, 2303–2310 (2022). https://doi.org/10.1007/s10792-022-02225-5

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