AB0961 UVEITIS IN PATIENTS WITH PSORIATIC ARTHRITIS

Abstract

Background Psoriatic arthritis (PsA) is a common disease in Departments of rheumatology. PsA affects from 5 % to 30 % of patients with psoriasis. The arthritis associated with psoriasis follows different patterns, including oligoarticular disease, polyarticular disease, distal interphalangeal disease, arthritis mutilans and axial disease. The axial disease often overlaps with the other four groups. Psoriatic arthritis belongs to the group of spondyloarthropathies in which uveitis is an associated disease. The prevalence of uveitis among PsA patients is not well established. Objectives The aim of this study is to describe the clinical characteristics of uveitis related to psoriatic arthritis. Methods Uveitis is described as an inflammation of the tissues that comprise the uveal tract (i.e., iris, ciliary body, and choroid). It can be classified either according to the anatomic parts of uvea that are involved or according to its underlying etiological cause. Anterior uveitis involves the iris and/or the ciliary body, intermediate uveitis involves the vitreous humor, while posterior uveitis is characterized by inflammation of the uvea and the choroid. A retrospective database study was conducted on 164 (96 female, 68 male, mean age 52,36±16,14 years) adult PsA patients with ocular symptoms. Demographic variables, smoking status, socioeconomic status (SES), body mass index (BMI), presence of selected chronic comorbidities, and medication use, including conventional and biologic disease modifying anti-rheumatic drugs (c/b DMARD) were extracted. We collected data about psoriasis type, uveitis laterality, onset type, human leukocyte antigen types, visual acuity, ocular inflammation localization, anterior segment findings, funduscopy findings, complications, recurrence, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis, and medical treatments for uveitis and skin diseases. Descriptive statistics was applied as appropriate. Cox proportional hazard regression time dependent models were used to calculate the risk of uveitis given demographic variables, SES, smoking, selected comorbidities, and c/bDMARD. P values of ≤ 0.05 were considered statistically significant. Results This study included a broad spectrum of ocular inflammation associated with PsA. We found that conjunctivitis was the most common problem, affecting 53 patients (32,32 %). Iritis (anterior uveitis) was found in 10 (6,1%), episcleritis - in 3 (1,83 %) and keratoconjunctivitis sicca - in 5 (3,05 %) patients. 14 patients were with axial involvement, seven of them with anterior uveitis. Patients with PsA and uveitis were more often female (7), of a younger age (48,25±15,4 years). In our cohort of patients uveitis is bilateral in 7 patients, all cases had acute non-granulomatous anterior uveitis. Anterior uveitis is usually accompanied by pain and redness of the eye without vision loss, while intermediate (1 patients) and posterior (2 patients) uveitis are mainly associated with visual symptoms such as floaters or blind spots and may affect central vision.Patients with uveitis had a previous history of uveitis and were more often treated with cDMARDS, monoclonal anti-Tumor Necrosis Factor-a (antiTNF-a) agents and etanercept. No difference in uveitis occurrence was noted regarding demographic characteristics and comorbidities. Conclusion Uveitis, in particular, is being considered as a relatively rare but very serious ocular complication of psoriasis. Patients with psoriasis should be educated about the increased risk and manifestations of uveitis. An ophthalmological consultation is needed when patients present with eye symptoms. Disclosure of Interests None declared