Aim To evaluate whether the risk of subsequent development of psoriasis and psoriatic arthritis is increased in patients with uveitis. Methods In the national health insurance research database of Taiwan, we identified 195,125 patients with new-onset uveitis between 2001 and 2013. We randomly selected 390,250 people without uveitis who were matched 2:1 with uveitis cases based on age, sex and year of registration. The characteristics of the two groups were compared. Using multivariate Cox regression, hazard ratios (HRs) for psoriasis or psoriatic arthritis corresponding to uveitis were calculated after adjustment for age, sex, insurance cost, and comorbidities. In subgroup analyses, separate HRs were calculated for mild psoriasis, severe psoriasis, and psoriatic arthritis. Results The mean age of the study cohort was 50.2 ± 17.2 years. Hypertension, diabetes, hyperlipidemia, and obesity were more prevalent in the uveitis group (all p < 0.0001). The risk of developing psoriasis or psoriatic arthritis was significantly higher in the uveitis group than in the non-uveitis group (p < 0.0001); this increased risk persisted after adjustment for confounders [adjusted HR = 1.41; 95% confidence interval (CI), 1.33–1.48]. Adjusted HRs showed an increasing trend from mild psoriasis (1.35; 95% CI, 1.28 to 1.44) to severe psoriasis (1.59; 95% CI, 1.30 to 1.94) to psoriatic arthritis (1.97; 95% CI, 1.60 to 2.42). Conclusions This nationwide population-based cohort study revealed that patients with uveitis have an increased risk of developing subsequent psoriasis or psoriatic arthritis. |
Comments
Taiwanese patients with uveitis were shown to have a higher risk of developing psoriasis and psoriatic arthritis than the general population, and hypertension, diabetes, and obesity were also more prominent in these populations.
Patients with uveitis may have an increased risk of psoriatic arthritis (PsA) and a severe psoriasis disease course, according to study findings published this week in PLoS One .
As an intraocular inflammatory disease, researchers observed that uveitis shares a similar pathogenesis to that of psoriasis, a condition that is also characterized by inflammation and immune reactions.
In previous research investigating the link between the 2 conditions, conflicting findings showed an inverse risk of uveitis in patients with psoriasis, and uveitis was also independently associated with psoriasis severity.
As one of the first studies to evaluate the risk of subsequent development of psoriasis and psoriatic arthritis in an Asian cohort of uveitis patients, the researchers conducted a nationwide population-based cohort study of individuals registered in the research database Taiwan’s national health insurance company.
“Very few studies have been conducted with a directional cohort approach from uveitis to psoriasis, and most studies to date have been conducted in Western countries,” the study authors noted.
In the study, data were collected from 195,125 patients with new-onset uveitis between 2001 and 2013 and compared with 390,250 people randomly selected from the general population matched for age, sex, and year of enrollment in a 1:2 ratio. mean (SD) age of the overall study cohort was 50.2 (17.2) years.
The risk of psoriasis or psoriatic arthritis corresponding to uveitis was assessed using multivariate Cox regression analysis, with separate subgroup analyzes performed to examine the risk of mild psoriasis, severe psoriasis, and psoriatic arthritis, and by type of uveitis (anterior, intermediate , posterior, panuveitis).
In particular, comorbidities known to positively correlate with psoriasis severity, including hypertension, diabetes, hyperlipidemia, and obesity, were found to be more prevalent in the uveitis group (all p < 0.0001). .
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; CI 95%, 1.33-1.48; P <0.0001). All types of uveitis were significantly associated with an increased risk of developing psoriasis or psoriatic arthritis.
Additionally, an increasing trend in risk by severity was observed from mild psoriasis (aHR, 1.35; 95% CI, 1.28-1.44) to severe psoriasis (aHR, 1.59; 95% CI, 95%, 1.30-1.94), with risk of psoriatic arthritis as well. 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 treating patients with uveitis. “Rheumatologists and dermatologists should also be alert to symptoms of uveitis, which may be early indicators of psoriatic arthritis,” the study authors concluded. "The use of a referral system and close cooperation between ophthalmologists, rheumatologists and dermatologists are important for the treatment of these patients."
