Uveitis: A Threat to Eyesight
Psoriasis and psoriatic arthritis can lead to the eye inflammation known as uveitis. Early diagnosis and treatment are key to preventing serious complications.
During a routine eye checkup in 2004, an optometrist explained to Sheree Thompson that, because she has psoriasis and psoriatic arthritis, she was at an increased risk of eye problems. The doctor told her to see an eye specialist immediately if she ever developed a loss of vision or other problems with her eyes.
"In early 2007, I experienced exactly what she had warned me about," said Thompson, a California native who now lives in Vancouver, Wash. By the time she could get an appointment the next day, "I couldn't see an eye chart."
The ophthalmologist diagnosed uveitis (pronounced "you-vee-EYE-tis"). The term refers to several different diseases related to inflammation within the eye. The disorder affects approximately one in 1,000 Americans, or 0.1 percent.
People who have psoriasis or psoriatic arthritis can indeed develop uveitis, said Dr. James T. Rosenbaum, an Oregon Health & Science University rheumatologist who specializes in autoimmune diseases that affect the eye. "Patients with psoriasis are slightly more likely (than the average person) to get uveitis," he said.
For patients with psoriatic arthritis, the risk is even higher—about 7 percent (or 70 people per 1,000) will develop uveitis. One study found that as many as 17 percent of children with psoriatic arthritis will get uveitis.
Probably all three diseases share a common genetic factor that makes psoriasis and psoriatic arthritis patients more prone to developing inflammatory eye disorders such as uveitis, Rosenbaum said.
Other autoimmune disorders, such as rheumatoid arthritis or lupus, and infections or injury may be associated with the development of uveitis, according to Mayo Clinic.
Uveitis related to psoriasis or psoriatic arthritis usually requires specific treatment for the eyes, with the goal of reducing inflammation, but sometimes systemic treatment for psoriasis or psoriatic arthritis helps uveitis.
Patients diagnosed with uveitis usually are prescribed corticosteroids, most commonly prednisone, as well as drugs that suppress the immune system. "But none of these drugs has been studied in controlled clinical trials for uveitis," according to Rosenbaum.
Steroids may help retain vision, but when taken orally can have debilitating side effects, including cataracts, glaucoma, diabetes, heart disease, osteoporosis and weight gain, and they can also make psoriasis worse.
Rosenbaum and other researchers are conducting clinical trials for voclosporin, a drug they hope will become the first oral medication for uveitis approved by the U.S. Food and Drug Administration. This drug is also being tested for psoriasis.
Uveitis symptoms may occur suddenly and worsen rapidly, as with Thompson, while in other cases symptoms develop gradually. They may be present in one or both eyes. "Sheree has had much worse eye inflammation than almost anyone [I've treated] in my practice," Rosenbaum said. "Uveitis with psoriasis represents a spectrum, from a temporary annoyance to, potentially, a vision-threatening problem."
One patient's experience with uveitis
Thompson developed psoriasis at age 5. The disease subsequently went into remission until she was about 11 or 12. In high school, she developed severe problems with the joints in her knees and wrists. Thompson's knee swelling became so severe that two different orthopedists recommended surgery.
In her early 20s, when she was scheduled to have a knee operation, she went to a family doctor for a routine matter. That physician noticed the psoriasis spots on her forehead, diagnosed psoriatic arthritis and referred her to a rheumatologist.
This doctor prescribed Enbrel and oral prednisone, which dramatically improved her psoriasis and psoriatic arthritis. But Thompson's uveitis did not improve, even after she went to two separate university specialists and tried various strategies to treat all three conditions.
Thompson, now 33, became a patient of Rosenbaum when she and her husband moved to Vancouver in 2009. After prescribing different drugs for her, Rosenbaum had her resume using steroid eye drops. She also has returned to taking Enbrel for her psoriatic arthritis, as well as increased doses of prednisone, and she uses the topical medication Elocon for her psoriasis. Through this regimen, Thompson has been able to manage her psoriasis and psoriatic arthritis well.
But her eyesight has not improved. She now is legally blind and has been on leave from her bank job since February. She uses eye drops to relieve increased pressure in her eyes. She also has cataracts in both eyes, but can't have them removed now because she is pregnant. She will have to wait until after her baby is born in January and she has had three months without eye inflammation.
Still, because pregnant women sometimes experience improvement in uveitis, psoriasis and psoriatic arthritis, Thompson hopes that she'll get better in the next few months. She maintains a positive attitude. "I've seen improvement in my body before. When I was first diagnosed with psoriatic arthritis, it was progressing so fast they thought within two to three years I would be in a wheelchair. Today I can walk and run."