Psoriatic Arthritis and Uveitis

Reviewed by: HU Medical Review Board | Last reviewed: October 2016. | Last updated: September 2019

Psoriatic arthritis increases the risk of developing uveitis, an inflammation of the eye that causes redness, pain, and can lead to vision loss. It is estimated that 7-9% of patients with psoriatic arthritis will develop uveitis.1-3

Uveitis is a term that refers to several different diseases related to inflammation in the eye. The inflammation can potentially destroy eye tissue, leading to vision loss. The word “uveitis” specifically refers to inflammation of the uvea, a vascular layer in the eye between the retina and the sclera. However, uveitis can also affect the other structures in the eye, including the lens, retina, optic nerve, and vitreous. Uveitis can occur at any age but it is most often seen in people between the ages of 20 and 60 years.1,2

Characteristics of uveitis

In some people, uveitis symptoms occur suddenly and worsen rapidly, while in others, uveitis occurs more gradually. As with other symptoms of psoriatic arthritis, uveitis presents with variety across patients, from an annoyance to possibly vision-threatening.1

Symptoms of uveitis include:

  • Blurry vision
  • Dark, floating spots in the vision (floaters)
  • Eye pain
  • Redness of the eye
  • Sensitivity to light (photophobia)1,2

Uveitis can occur in one or both eyes. It may first appear in one eye but then recur in either eye. It is significantly more frequent in patients with psoriatic arthritis who are positive for human leukocyte antigen (HLA)-B27. HLA are the molecules present on the surface of all cells that are almost unique for each person. HLA is what helps the body’s immune system identify itself as well as identify foreign invaders. It is believed that this identification process goes awry in autoimmune diseases like PsA.3,5,6

How is uveitis diagnosed?

Uveitis is detected through an eye examination performed by an ophthalmologist. Several tests are used, including:

  • Visual acuity test, using an eye chart to test vision
  • Funduscopic exam, in which the pupil is dilated with eye drops to allow the doctor to use an ophthalmoscope to view the inside of the eye
  • Ocular pressure, using an instrument such as a tonometer or a tonopen to measure the pressure inside the eye
  • Slit Lamp Exam, in which a dye may be added to the eye to allow the doctor to view the blood vessels in the eye2

How is uveitis treated?

Early treatment of uveitis is important to reduce the risk of complications, and patients with eye pain, severe light sensitivity, or any change in vision should immediately see an ophthalmologist for examination. Uveitis can cause permanent vision damage, even with treatment. Additional complications may include cataracts, fluid within the retina, glaucoma, retinal detachment, and vision loss or blindness.2,7

While systemic treatments for PsA that reduce inflammation will help in reducing the inflammation of uveitis, specific treatment for the eyes is usually also required. Treatment for uveitis usually includes steroidal anti-inflammatory medication that may be taken as eye drops, pills, injections around or into the eye, intravenous (IV) administration, or a capsule that is surgically implanted inside the eye.1,2,5

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