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Although psoriatic arthritis (PsA) is usually thought of as a joint disease, it can also cause uveitis, a lesser-known eye condition that leads to inflammation and can affect vision. For some people, this may be a sign of a PsA flare, alongside other symptoms like joint pain and fatigue.
“I’ve been struggling with uveitis from my psoriatic arthritis, and nothing is helping,” one MyPsoriasisTeam member wrote. Another said, “I also have uveitis. I’ve been treated for about a year and a half, and it’s improving.”
People with severe PsA have an increased risk of uveitis (also known as ocular inflammation) compared to the general population. Uveitis is also more common in people who have PsA (with or without psoriasis) than in people who have psoriasis alone.
Although uveitis that keeps coming back isn’t common in psoriatic disease, it can be serious. If you think your PsA may be causing eye or vision problems, talk with your healthcare provider or rheumatologist.
Uveitis is an inflammatory disorder that affects the middle layer of the eye, called 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 types of uveitis, based on where the inflammation is in the eye and whether it comes on quickly or lasts a long time.
Uveitis can be short term or long term. Acute uveitis comes on quickly and usually gets better within three months. Chronic uveitis lasts longer and can flare up again months after treatment stops.
Anterior uveitis is the most common form of uveitis. It usually affects the iris or the ciliary body.
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 happens when the middle part of the eye becomes inflamed. It affects the vitreous, peripheral retina, and the pars plana region of the eye, which is a part of the ciliary body. Intermediate uveitis can lead to blurry vision and floaters, or spots and flecks in your field of vision.
Posterior uveitis causes inflammation in the choroid (back part of the uvea) or the back of the retina. This rare form of uveitis may affect the retina and optic nerve, and it can lead to permanent vision loss.
In some cases, inflammation can show up in both the front and back of the eye. This condition is called panuveitis. It can cause a mix of symptoms, like eye pain, redness, blurry vision, and floaters.
Uveitis can affect one or both eyes. The symptoms caused by inflammation can develop suddenly or build gradually over several days. These symptoms include:
Uveitis is often mistaken for viral conjunctivitis (pink eye). Pink eye is common and usually causes swollen eyelids and a sticky, mucus-like discharge, and it often feels gritty or itchy rather than severely painful. However, viral conjunctivitis is unlikely to cause eye pain, light sensitivity, and vision loss (in severe cases) more commonly seen in uveitis.
It may not be easy to tell uveitis 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 or uveitis and said to get in to my eye doctor as soon as I could.”
Fortunately, this member shared that their pain started improving within 12 hours: “By hour 20, it was 90 percent better.”
According to Mayo Clinic, the exact cause of uveitis is unclear in about half of the people who develop it. However, a known cause of uveitis is autoimmune conditions like lupus, Crohn’s disease, and PsA.
The immune system usually protects your body from invaders, but in autoimmune diseases, it mistakenly attacks the body’s own healthy tissues. When the immune system targets the eyes, it can cause uveitis. The immune system sends inflammation-causing cells into the blood vessels in the uvea, which can lead to swelling and damage.
Uveitis must be treated as soon as possible, and recurrent episodes must be prevented to avoid vision loss and other complications. Your doctor or eye specialist can help figure out what’s causing your symptoms and how to treat them.
Treating uveitis usually has three goals. Your healthcare provider will work to reduce your pain and discomfort, lower your inflammation, and then treat any underlying conditions, like PsA, that may be causing or contributing to uveitis. Most of the time, treating eye problems like uveitis also involves regular eye exams. These help monitor your eye health.
Most cases of uveitis can be treated with anti-inflammatory medications like steroids, also called corticosteroids. When used for uveitis, steroid medications are available in different forms, including eye drops, ocular (eye) injections, ocular implants, and pills. 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.”
Your healthcare provider might also recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation.
Pain-relieving medications for uveitis include eye drops that control spasms, like cycloplegics. These medications help calm the spasms and reduce the pain. They can also keep the pupil open, which helps prevent more pain and stiffness in the eye.
Medications that target your immune system, like biologics (made from living cells), may help control eye inflammation from uveitis. Your doctor may prescribe these drugs if your uveitis is severe and doesn’t get better with other treatments.
Your healthcare provider may recommend antibiotic and antiviral medications if your uveitis is caused by an infection. Antibiotics help fight bacterial infections, while antiviral medications help fight viruses.
If your uveitis continues despite treatment or proves challenging to manage, your doctor might suggest an implant placed inside your eye. The implant gradually delivers corticosteroids to help reduce inflammation.
Uveitis can be a serious eye problem for people with PsA, even though it isn’t common. Learning the warning signs and getting treatment fast can help protect your vision. If you notice eye pain, redness, light sensitivity, floaters, or blurry vision, contact your healthcare provider or eye doctor right away. Keeping your PsA under control may also help lower your risk of future eye flares.
On MyPsoriasisTeam, people share their experiences with psoriasis, get advice, and find support from others who understand.
How have you managed uveitis associated with PsA? Let others know in the comments below.
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True .on very hot duny days the tesrs judt stsrt streaming out of my eyes.I use very dsrk sunglasses.
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