Background/Purpose:

Psoriatic disease is characterized by the presence of psoriasis with or without an association of extra-dermal manifestations. Inflammatory forms of arthritis are the most common concomitant findings in this continuum but not infrequently other organ systems manifest involvement. There is a dearth of primary literature on autoimmune ocular manifestations in patients with Psoriasis (Ps) and Psoriatic arthritis (PsA) although the prevalence of uveitis in PsA has been documented to be as high as 25.1%. ¹

The purpose of this study is to describe the pattern of ocular inflammation in patients with psoriatic disease.

Methods:  Retrospective chart review of ocular manifestations in patients with Ps and PsA from two tertiary care centers in the United States specializing in autoimmune ophthalmic disease.  Data was collected on age, gender, ethnicity, associated autoimmune disease, ocular manifestations, HLA Typing, systemic immunomodulating agents and ocular therapy

Results:

20 patients were identified with the following characteristics:

Age in years at Diagnosis of Ophthalmic Disease mean +/- SD	45.9 SD +/- 14.4
Male/Female	5/15
Race	1 Hispanic, 2 African Americans. 17 Caucasians
Psoriatic Disease	6 Ps, 14 PsA
Additional Systemic Illnesses	3 Sarcoid, 2 RA
Pattern of PsA	8 Oligoarticular, 2 Axial, 1 Polyarticular (not available in 3 pts)
Ophthalmic Illness	6 Anterior Uveitis, 3 Panuveitis 2 Scleritis, 1 Episcleritis, 3 Sclerouveitis, 2 PUK, 1 Vasculitis, 1 Multifocal Choroiditis
Systemic Therapy	Systemic and Local Steroids, Sulfasalzine, Methotrexate, Mycophenolate, Cyclosporin, Adalimumab, Infliximab, Certolizumab, Etanercept, Cytoxan, Rituximab
Number of Patients Requiring More than One Immunomodulatory Medication	11

Conclusion:

The breadth and severity of ocular manifestations in patients with Ps and PsA is diverse. This is the largest cohort of patients with autoimmune ophthalmic manifestations and psoriatic disease described to date. There are several unique features of this cohort:

1.  30% of patients had only skin disease. 

2.  Although it appears that anterior uveitis is the most common autoimmune ocular manifestation of this group of diseases in this cohort of patients it tends to be chronic, differentiating this ocular manifestation from the pattern in Ankylosing Spondylitis.

3.  33% of patients had an overlap of two underlying systemic autoimmune diseases.  

4.  When ocular manifestations do occur in patients with psoriatic disease, they tend to be more severe and require more than one immunomodulatory therapy.

5.  The most common pattern of PsA in patients with autoimmune ophthalmic disease is the oligoarticular form. 

1.Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis. 2008;67(7):955-9. Epub 2007/10/27. doi: ard.2007.075754

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-spectrum-of-autoimmune-ophthalmic-manifestations-in-psoriatic-disease/