Psoriatic arthritis (PsA) is a form of chronic inflammatory arthritis. It affects about 30 percent of people with skin psoriasis. PsA occurs when the body’s immune system mistakenly attacks its own healthy tissues. The main symptoms of psoriatic arthritis are joint pain, swelling, and stiffness. However, PsA has an impact on the immune system, which means it can affect many different parts of the body — not just the joints.
In some cases, people with psoriatic arthritis can develop uveitis, or ocular (eye) inflammation. This inflammation usually affects both eyes and is chronic and severe.
Research has shown that people with severe psoriatic arthritis have an increased risk of uveitis compared to the general population. The prevalence of uveitis also tends to be higher in individuals with both psoriasis and PsA or PsA alone than in those with just psoriasis. Although it’s a relatively rare complication of psoriatic disease, uveitis is considered very serious. Talk to your doctor or rheumatologist if you suspect your PsA is affecting your eyes and vision.
Uveitis is an inflammatory disorder that affects the middle layer of the eye, known as the uvea or uveal tract. The uvea contains several structures:
Uveitis can affect different structures in the uvea, causing vision changes and eye pain, among other symptoms. There are several different types of uveitis, identified by where the inflammation occurs and how long it lasts.
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Anterior uveitis is the most common form of uveitis. It accounts for approximately 3 in 4 cases of uveitis. There are two types of anterior uveitis: iritis, which affects the front chamber of the eye and the iris, and iridocyclitis, which also involves the ciliary body.
As its name suggests, anterior uveitis affects the anterior uveal tract (the portion of the uvea found in the front of the eye). Anterior uveitis tends to come on quickly and can cause eye redness and pain, which may be severe. As one MyPsoriasisTeam member shared, “I’ve been in the hospital today with the worst eye pain I’ve ever experienced. It seems I have acute anterior uveitis — an inflammation linked to psoriasis, which I had never heard of.”
Intermediate uveitis occurs in the middle portion of the eye just behind the iris and lens. Intermediate uveitis can lead to blurred vision and floaters, or spots and flecks in the field of vision.
As its name suggests, posterior uveitis — also known as choroiditis — causes inflammation in the choroid, or back portion of the uvea. This rare form of uveitis may affect the retina and optic nerve, potentially leading to permanent vision loss.
In some cases, inflammation can occur in both the front and back of the eye. This condition is referred to as panuveitis.
Acute uveitis refers to any type of uveitis that develops quickly and improves within three months.
Chronic uveitis occurs when uveal inflammation is long-lasting and comes back within three months of stopping treatment.
Recurrent uveitis refers to uveitis that develops in repeated episodes, with several months between each episode.
Uveitis can affect one or both eyes. The symptoms caused by inflammation from uveitis can develop suddenly, as in acute uveitis, or build gradually over several days. These symptoms include:
Uveitis is often mistaken for viral conjunctivitis, or “pink eye.” Pink eye is characterized by swollen eyelids and mucus discharge. However, it is unlikely to cause the eye pain, light sensitivity, and vision loss (in severe cases) more commonly seen in uveitis. It may not always be easy for someone with uveitis to tell it apart from everyday eye irritation. For this reason, it’s important to see a doctor or ophthalmologist (eye specialist) if you experience any eye symptoms, especially if they’re not going away or are getting worse.
Members of MyPsoriasisTeam have shared their experiences with eye inflammation, including what it felt like and when they knew something was wrong.
As one member shared, “I woke up in the middle of the night with screaming eye pain. I could only get in to my primary care provider, who suspected iritis/uveitis and said to get in to my eye doctor as soon as I could.” Luckily, this member shared that their pain started improving within 12 hours. "By hour 20, it was 90 percent better.” However, they did the right thing by seeing their doctor.
In people with autoimmune diseases, including psoriatic diseases like PsA, the immune system mistakenly attacks the body’s own healthy tissues. The overactive immune system can target multiple areas of the body, including the eyes. When the immune system mounts an attack against foreign invaders, it releases inflammatory cells. These cells can enter the many blood vessels in the uvea, causing damage and inflammation.
Certain antibodies (proteins that play a role in the immune response) are thought to be involved in the development of uveitis. Two of these antibodies are tumor necrosis factor-alpha (TNF-alpha) and HLA-B27. According to one study, HLA-B27 has been found to play a role in 30 percent to 40 percent of uveitis cases in people with PsA.
As one MyPsoriasisTeam member noted, “You need to see an ophthalmologist because these conditions can be very dangerous, but can be cleared up quickly with combination steroid and antibiotic drops. The symptoms can come and go, but if left untreated, you could lose your sight.”
Uveitis must be treated with anti-inflammatory drugs or immunomodulators, such as biologic medications, to prevent vision loss and other complications. Your doctor or ophthalmology expert can help you understand the cause of your eye symptoms and determine the best ways to manage them.
Psoriasis-related uveitis is more likely to require treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) than other forms of uveitis. Oral NSAIDs have been found to reduce the relapse rate of recurrent anterior uveitis.
Most cases of uveitis can be treated with steroids — medications that prevent the immune system from releasing inflammation-causing chemicals. Steroid medications are available in different forms, including eye drops, ocular injections, and ocular implants. The type of medication your doctor prescribes depends on which parts of your eye are inflamed.
One MyPsoriasisTeam member experiencing uveitis was advised to combine pain-relieving medications and steroid eye drops: “I’m on hourly steroid drops and painkillers.”
Biologic medications belong to a group of drugs known as disease-modifying antirheumatic drugs (DMARDs). Biologic therapy helps control eye inflammation and prevent relapses by targeting specific parts of the immune system that cause inflammation. Some biologics that may be prescribed to treat uveitis include adalimumab (sold as Humira) and Inflectra (infliximab).
MyPsoriasisTeam is the social network for people with psoriasis and PsA and their loved ones. On MyPsoriasisTeam, members ask and answer questions, share their stories, and provide much-needed support.
Have you developed uveitis alongside psoriatic arthritis? How was your eye inflammation treated? Share your experiences with others by joining MyPsoriasisTeam and leaving a comment below or creating a new post.