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Original Investigation |

Association of Psoriatic Disease With Uveitis A Danish Nationwide Cohort Study

Alexander Egeberg, MD1; Usman Khalid, MD1; Gunnar Hilmar Gislason, MD, PhD1,2,3; Lotus Mallbris, MD, PhD4; Lone Skov, MD, PhD, DMSc5; Peter Riis Hansen, MD, PhD, DMSc1
[+] Author Affiliations
1Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
2The Danish Heart Foundation, Copenhagen, Denmark
3National Institute of Public Health, University of Southern Denmark, Copenhagen
4Unit of Dermatology and Venereology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
5Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
JAMA Dermatol. 2015;151(11):1200-1205. doi:10.1001/jamadermatol.2015.1986.
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Importance  Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. Limited evidence is available about the relationship between psoriatic disease and uveitis.

Objective  To investigate the potential bidirectional relationship between psoriatic disease, including psoriasis and psoriatic arthritis, and uveitis.

Design, Setting, and Participants  We performed a nationwide cohort study of the Danish population from January 1, 1997, through December 31, 2011. We included 74 129 Danish patients with psoriasis who were 18 years or older during the study period. Patients were identified through administrative registries, and information on age, sex, socioeconomic status, medication, and comorbidity was obtained using individual-level linkage of administrative registers. We performed data analysis from January 27 through March 4, 2015.

Exposures  Diagnosis of mild or severe psoriasis or psoriatic arthritis for uveitis risk and diagnosis of uveitis for the risk for psoriasis or psoriatic arthritis.

Main Outcomes and Measures  Diagnosis of uveitis, mild psoriasis, severe psoriasis, or psoriatic arthritis. We calculated incidence rates (IRs) and estimated IR ratios adjusted for potential confounders using Poisson regression.

Results  We identified 74 129 cases of psoriasis and psoriatic arthritis and 13 114 cases of uveitis. The IRs (95% CIs) for uveitis were 2.02 (1.99-2.06), 2.88 (2.33-3.56), 4.23 (2.40-7.45), and 5.49 (3.36-8.96) for the reference population and those with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. In the reference population, these IRs (95% CIs) were 9.37 (9.30-9.45), 1.12 (1.10-1.15), and 1.04 (1.01-1.06), and in patients with uveitis, these statistics were 15.51 (12.92-18.62), 2.66 (1.72-4.13), and 4.25 (3.00-6.01) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Adjusted IR ratios (95% CIs) for uveitis were 1.38 (1.11-1.70 [P = .02]), 1.40 (0.70-2.81 [P = .34]), and 2.50 (1.53-4.08 [P < .001]) for patients with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. For patients with uveitis, IR ratios (95% CIs) were 1.59 (1.32-1.91 [P < .001]) for mild psoriasis, 2.17 (1.40-3.38 [P < .001]) for severe psoriasis, and 3.77 (2.66-5.34 [P < .001]) for psoriatic arthritis, respectively.

Conclusions and Relevance  We found a bidirectional association between psoriatic disease and uveitis. Increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with prior or current uveitis may be appropriate.

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