For those living with psoriatic arthritis (PsA), achy joints and difficulty moving are just the beginning of the story. From an increased risk of cardiovascular disease to the emotional impact of PsA, balancing your joint health while properly monitoring and treating comorbidities is a lot to consider, and it may require a team of specialists. So you visit the rheumatologist for your joints, a dermatologist for your skin. But how can optometrists and ophthalmologists play a role in your psoriatic disease care?
About 7 percent of those with PsA will develop uveitis (pronounced “you-vee-EYE-tis”), a medical term referring to several different diseases related to inflammation within the eye. The most common form is anterior uveitis, which affects the inner wall of the ciliary body (containing the iris).  This 7 percent figure is much higher than for the general population, which sees a risk of uveitis closer to 0.1 percent. 
The reason for the increased risk is not explicitly clear, according to James Rosenbaum, M.D., a rheumatologist and ophthalmologist at Oregon Health and Science University. He discussed uveitis and the risk to those living with psoriatic disease in a 2019 NPF Psound Bytes™ podcast episode titled “Psoriatic Arthritis and Uveitis: What’s It All About?”
“Why do you get uveitis with (psoriatic) arthritis together? That is a mystery – just [like] getting skin disease and joint disease together,” says Dr. Rosenbaum.
He points out that there are some similarities between your eyes and your joints – like the presence of collagen and hyaluronic acid in both – that could indicate an association between PsA and other parts of the body that do not seem inherently linked. The nature of autoimmune disease – or immune-mediated disease, in the case of psoriasis and PsA – also could be the link to higher risk, as people with lupus and rheumatoid arthritis also have a higher risk of uveitis.
What is clear is how disruptive PsA can be to you, whether in your eyes or your joints.
According to rheumatologist Rebecca Haberman, M.D., a clinical instructor at New York University Grossman School of Medicine, uveitis symptoms can be wide-ranging and can affect your vision. “The most common symptoms are eye redness and pain and can occur in one eye or both,” says Dr. Haberman. “Other symptoms that can occur include blurred vision, sensitivity to light, and small or irregular shaped pupils.”
It is important to stay on top of an annual eye exam, especially for those with psoriasis because they are at a higher risk for developing PsA. Presence of mild inflammation could be an indication of the early stages of PsA development, since uveitis is a strong risk factor for PsA, says Dr. Haberman. “While PsA cannot be diagnosed or discovered through an eye exam alone, uveitis can occur before PsA development or may be a first presenting sign of psoriatic disease.”
As with flares in your joints, uveitis can appear with similar frequency, depending on mitigating outside factors like stress, weather and irritants in the eye. If not properly treated, anterior uveitis can lead to permanent eye damage, says Dr. Haberman. That is why it is important to seek medical help if you are experiencing any of these symptoms. Early diagnosis and treatment can go a long way in avoiding permanent eye damage.
“For any pain, redness or blurred vision, you should see an ophthalmologist right away to determine if you have uveitis,” says Dr. Haberman. “And then discuss the findings with your rheumatologist (or dermatologist).”
As for treating uveitis, it really depends on the severity of inflammation. Dr. Haberman says mild-to-moderate symptoms might be treated with steroid eye drops when the inflammation occurs. For more severe symptoms, an oral steroid might be administrated. And for some people, finding the right treatment for psoriatic disease can help lead to reduced inflammation. “Medication used to treat psoriasis and psoriatic arthritis may also be used, such as oral small molecules like methotrexate and biologic agents such as adalimumab and infliximab,” says Dr. Haberman.
Getting an early start can help lead to more effective treatment. For those with PsA who live with occasional eye inflammation, Dr. Haberman says the best thing you can do for yourself is find a PsA treatment that works and stick with it.
“It is important to stay on your medications,” she says. “Especially if you have recurrent uveitis, staying on your medications can reduce the risk of repeat episodes.”