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Güneş İB, Aksoy B, Öztürk H, Yavrum F, Özen B. Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study. An Bras Dermatol 2023; 98:781-786. [PMID: 37355351 PMCID: PMC10589481 DOI: 10.1016/j.abd.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity ındex (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool. OBJECTIVE To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis. METHODS 175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined. RESULTS The mean CCET value was 58.06±3.1μm in the mild group, 60.10±5.0μm in the moderate group, 65.75±6.3μm in the severe group and 56.16±3.1μm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p<0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p=0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p<0.001). There was a strong positive correlation between PASI score and CCET (p<0.001, r=0.519). STUDY LIMITATIONS Cross-sectional design and a relatively small number of participants. CONCLUSIONS There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.
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Affiliation(s)
- İrfan Botan Güneş
- Department of Ophthalmology, Kocaeli Health and Technology University, Medical Park Kocaeli Hospital, Kocaeli, Turkey.
| | - Berna Aksoy
- Department of Dermatology, Medical Park Kocaeli Hospital, Kocaeli, Turkey
| | - Hakan Öztürk
- Department of Ophthalmology, University of Health Sciences, Tepecik Hospital, Izmir, Turkey
| | - Fuat Yavrum
- Department of Ophthalmology, Alaaddin Keykubat University, Alanya, Turkey
| | - Bediz Özen
- Department of Ophthalmology, University of Health Sciences, Tepecik Hospital, Izmir, Turkey
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2
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Sedghi T, Torre K, Suchecki J, Rothe M. The ocular and periocular involvement of psoriasis. Clin Dermatol 2023; 41:515-522. [PMID: 37619649 DOI: 10.1016/j.clindermatol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Ocular manifestations of psoriasis are generally underrepresented in the literature and can often be missed by clinicians. Appreciation of eye involvement in psoriasis is especially important for dermatologists and ophthalmologists who may be closely involved with treating afflicted patients. Depending on the involved site and severity of the condition, signs and symptoms of ocular psoriasis can vary from asymptomatic erythema to debilitating scarring and vision loss. Treatment is critical to prevent disease progression and to improve the quality of life for these patients. We discuss the various clinical manifestations and treatment options for ocular complications in patients with psoriasis, including specific circumstances that should trigger immediate referral to our ophthalmology colleagues.
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Affiliation(s)
- Tannaz Sedghi
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kristin Torre
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jeanine Suchecki
- Department of Surgery, Division of Ophthalmology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Marti Rothe
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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3
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Burek-Michalska A, Turno-Kręcicka A, Grant-Kels JM, Grzybowski A. Biologic therapies for psoriasis and eyes. Clin Dermatol 2023; 41:523-527. [PMID: 37586569 DOI: 10.1016/j.clindermatol.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Psoriasis is a systemic inflammatory disorder, manifested mainly by skin lesions, but the inflammation also may affect the joints and eye. Many comorbidities have been described in association with psoriasis, including metabolic syndrome and coronary plaques. The pathomechanism of psoriasis is multifaceted. Both genetic and immunologic aspects play a role in stimulating inflammation. Genetic susceptibility is conditioned by presence of the human leukocyte antigen-C*06:02 risk allele and the inflammatory reaction secondary to cytokines, such as tumor necrosis factor α, interleukin 17 (IL-17), IL-20, IL-23, and interferon alfa. Besides the conventional therapy of topical steroids and immunosuppressants, biologic therapies are widely used in the treatment of psoriasis, psoriatic arthritis, and coexisting uveitis. In the majority of cases, biologic therapy has a beneficial effect on uveitis, but in some cases, some of these drugs can lead to serious side effects threatening vision.
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Affiliation(s)
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
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4
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Chen B, Yang S, Zhu L, Peng X, He D, Tao T, Su W. Adalimumab plus Conventional Therapy versus Conventional Therapy in Refractory Non-Infectious Scleritis. J Clin Med 2022; 11:jcm11226686. [PMID: 36431163 PMCID: PMC9697705 DOI: 10.3390/jcm11226686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Long-term systemic glucocorticoids and non-specific immunosuppressants remain the mainstay of treatment for refractory scleritis, and result in serious side-effects and repeated inflammation flares. To assess the efficacy and safety of additional adalimumab, patients diagnosed with refractory non-infectious scleritis were enrolled. They were assigned to the conventional-therapy (CT, using systemic glucocorticoids and other immunosuppressants) group or the adalimumab-plus-conventional-therapy (ACT) group according to the treatments they received. The primary outcome was time to achieve sustained remission, assessed by a reduction in modified McCluskey's scleritis scores. Other outcomes included changes in McCluskey's scores, scleritis flares, best-corrected visual acuity, and spared glucocorticoid dosage. Patients in the ACT group achieved faster remission than those in the CT group, as the median periods before remission were 4 months vs. 2.5 months (p = 0.016). Scleritis flares occurred in 11/11 eyes in the CT group and 5/12 eyes in the ACT group (p = 0.005). Successful glucocorticoid sparing was realized in both groups, but the ACT group made it faster. No severe adverse events were observed. Data suggest that adalimumab plus conventional therapy could shorten the time to remission, reduce disease flares, and accelerate glucocorticoid withdrawal compared with conventional therapy alone.
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Affiliation(s)
- Binyao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Lei Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xuening Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Daquan He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Tianyu Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Correspondence: (T.T.); (W.S.)
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Correspondence: (T.T.); (W.S.)
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5
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Hong JJ, Hadeler EK, Mosca ML, Brownstone ND, Bhutani T, Liao WJ. TNF-alpha inhibitors and ustekinumab for the treatment of psoriasis: therapeutic utility in the era of IL-17 and IL-23 inhibitors. JOURNAL OF PSORIASIS AND PSORIATIC ARTHRITIS 2022; 7:79-92. [PMID: 35757187 PMCID: PMC9229820 DOI: 10.1177/24755303211047479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psoriasis is a chronic inflammatory condition for which eleven FDA-approved biologic therapies are approved. Over the past decade, studies have documented the higher efficacy of IL-17 and IL-23 inhibitors for the treatment of psoriasis compared to the TNF-alpha inhibitors and ustekinumab, an IL-12/23 inhibitor. Despite this, there remains an important role for the use of TNF-alpha inhibitors and ustekinumab in the treatment of psoriasis. Here, we review how considerations of infection and malignancy risk, patient demographics, treatment resistance, and co-morbidities may make certain TNF-alpha inhibitors or ustekinumab an excellent choice for therapy in particular patient subgroups.
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Affiliation(s)
- Julie J Hong
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Edward K Hadeler
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Megan L Mosca
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Nicholas D Brownstone
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Tina Bhutani
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
| | - Wilson J Liao
- University of California San Francisco, Department of Dermatology, Psoriasis and Skin Treatment Center
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6
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Abdel-Aty A, Gupta A, Del Priore L, Kombo N. Management of noninfectious scleritis. Ther Adv Ophthalmol 2022; 14:25158414211070879. [PMID: 35083421 PMCID: PMC8785299 DOI: 10.1177/25158414211070879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Scleritis is a manifestation of inflammatory eye disease that involves the sclera. It can be divided into multiple subtypes, including diffuse anterior, nodular anterior, necrotizing, and posterior scleritis. In many cases, scleritis is restricted to the eye; however, it can occur in the context of systemic illness, particularly autoimmune and infectious conditions. Patients with autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and polyangiitis with granulomatosis, may develop scleritis flares that may require topical and systemic therapy. Initial therapy typically involves oral nonsteroidal anti-inflammatory drugs (NSAIDs); however, it is important to address the underlying condition, particularly if systemic. Other treatment regimens typically involve either local or systemic steroids or the use of immunomodulatory agents, which have a wide range of efficacy and documented use in the literature. There is a myriad of immunomodulatory agents used in the treatment of scleritis including antimetabolites, calcineurin inhibitors, biologics, and alkylating agents. In this review, we highlight the various subtypes of noninfectious scleritis and explore each of the mainstay agents used in the management of this entity. We explore the use of steroids and NSAIDs in detail and discuss evidence for various immunomodulatory agents.
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Affiliation(s)
- Ahmad Abdel-Aty
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Akash Gupta
- Department of Medicine, School of Medicine, Yale University, 20 York Street, New Haven, CT 06510, USA
| | - Lucian Del Priore
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
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7
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Köse B, Uzlu D, Erdöl H. Psoriasis and uveitis. Int Ophthalmol 2022; 42:2303-2310. [DOI: 10.1007/s10792-022-02225-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/09/2022] [Indexed: 02/08/2023]
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8
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Identifying and Treating Ocular Manifestations in Psoriasis. Am J Clin Dermatol 2022; 23:51-60. [PMID: 34731450 DOI: 10.1007/s40257-021-00648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/04/2023]
Abstract
Psoriasis is a chronic immune-mediated inflammatory skin condition that commonly presents with red, thickened, and scaling plaques. Given the prominent cutaneous manifestations of psoriasis, more subtle ophthalmic findings of the disease may initially go undetected, with the potential for significant ocular morbidity. Associated ocular disease can involve nearly any structure of the eye, with the eyelids most commonly being affected, resulting in relatively common signs and symptoms of ocular surface discomfort. The presence of intraocular inflammation (i.e., uveitis) or retinal involvement carry a heightened risk of vision loss, and are often more difficult to diagnose outside of the ophthalmology clinic. Early detection and treatment of ocular disease can limit morbidity and are critical to the management of these patients, which requires coordination of care between dermatologists and ophthalmologists. The objective of this article was to review the most common ocular conditions that affect psoriatic patients, when to consider referral to an ophthalmologist, and to summarize the adverse ocular effects of current psoriasis treatments.
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9
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Sota J, Girolamo MM, Frediani B, Tosi GM, Cantarini L, Fabiani C. Biologic Therapies and Small Molecules for the Management of Non-Infectious Scleritis: A Narrative Review. Ophthalmol Ther 2021; 10:777-813. [PMID: 34476773 PMCID: PMC8589879 DOI: 10.1007/s40123-021-00393-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023] Open
Abstract
Scleritis refers to a wide spectrum of ocular conditions ranging from mild to sight-threatening scleral inflammation that may compromise visual function and threaten the anatomical integrity of the ocular globe. Most aggressive forms like necrotizing or posterior scleritis are often difficult-to-treat cases, refractory to conventional treatment. The association with systemic diseases, namely rheumatoid arthritis, Sjögren syndrome, granulomatosis with polyangiitis, and relapsing polychondritis, may have prognostic implications as well. A better understanding of the pathogenesis of ocular inflammatory diseases have paved the way to more effective and targeted treatment approaches. In this regard, a growing body of evidence supports the potential role of biologic agents in the management of non-infectious scleral inflammation, either idiopathic or in a background of immune-mediated systemic disorders. Biologic agents such as anti-tumor necrosis factor agents, interleukin-1 and interleukin-6 inhibitors as well as CD20 blockade have displayed promising results. More specifically, several studies have reported their ability to control scleral inflammation, reduce the overall scleritis relapses, and allow a glucocorticoid-sparing effect while being generally well tolerated. Anecdotal reports have also been described with other biologic agents including abatacept, ustekinumab, daclizumab, and alemtuzumab as well as targeted small molecules such as tofacitinib. Further studies are warranted to fully elucidate the role of biologic agents in non-infectious scleritis and investigate specific areas with the aim to administer treatments in the context of personalized medicine. This review summarizes the available data regarding clinical trials, small pilot studies, and real-life experience of the last two decades reporting the use of biologic agents in the management of non-infectious scleritis.
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Affiliation(s)
- Jurgen Sota
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, University of Siena, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Matteo-Maria Girolamo
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, University of Siena, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, University of Siena, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy.
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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10
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Analysis of corneal densitometry and endothelial morphometry in patients with psoriasis. Photodiagnosis Photodyn Ther 2021; 36:102522. [PMID: 34487872 DOI: 10.1016/j.pdpdt.2021.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND To evaluate corneal endothelial properties and corneal densitometry values in patients with psoriasis and to compare the results with those of healthy controls. METHODS This prospective, comparative, and cross-sectional study included 106 eyes of 53 patients who were diagnosed with psoriasis and 106 eyes of 53 age-gender matched healthy controls. All patients were evaluated in terms of ocular surface tests such as Schirmer-1 and tear break-up time (TBUT). Corneal endothelial measurements were performed using noncontact specular microscopy. Corneal tomographic and densitometric measurements were obtained using the Scheimpflug imaging system. Measurements were also evaluated according to the psoriasis area and severity index (PASI) score. RESULTS The mean TBUT and Schirmer 1 test values were significantly lower in the psoriasis group than in the healthy controls (p = 0.02, p < 0.001, respectively). While the mean endothelial cell density was significantly lower in patients with psoriasis than the healthy controls (2389.9±314.9 cells/mm2 vs. 2512.4±289.7 cells/mm2, p = 0.02), the mean average endothelial cell area, standard deviation of cell area, coefficient of variation of cell area were significantly higher in patients with psoriasis (426.6±62.7 µm2 vs. 403.2±46.1 µm2, p = 0.01; 206.4±52.3 µm2 vs. 183.2±43.8 µm2, p = 0.006; and 48.1±6.3% vs. 45.7±6.7%, p = 0.04, respectively). Most of the densitometry measurements in concentric zones were higher in patients with psoriasis than in healthy controls, but none of the differences reached statistical significance. CONCLUSIONS A regular eye examination is crucial in patients with psoriasis because corneal structural and functional changes, particularly endothelial alterations, are of utmost importance in planning intraocular surgeries in patients with psoriasis.
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11
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Lu J, Tang S, Yu N, Yi X, Li Y. Successful secukinumab treatment of erythrodermic psoriasis and psoriatic arthritis concomitant with severe noninfectious uveitis: a case report. J Int Med Res 2021; 48:300060520969494. [PMID: 33161790 PMCID: PMC7658516 DOI: 10.1177/0300060520969494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Uveitis is considered a relatively rare but serious ocular complication of psoriasis. We report the first successful treatment of severe noninfectious uveitis with secukinumab in a 70-year-old woman with erythrodermic psoriasis and psoriatic arthritis. Anti-tumor necrosis factor (TNF) agents were administered for 5 years for the treatment of erythrodermic psoriasis and psoriatic arthritis. Although the symptoms improved, she later developed noninfectious uveitis, resulting in a sharp decline in vision. After switching to secukinumab, her vision slightly improved, her skin lesions subsided, and her joint symptoms were relieved. Given the rarity of psoriasis combined with uveitis, it is unclear whether uveitis is related to anti-TNF therapy. In addition, the selection of effective biological agents for the treatment of uveitis remains a challenge and requires extensive clinical experience.
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Affiliation(s)
- Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Suwei Tang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ning Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuemei Yi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
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12
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Lam M, Steen J, Lu JD, Vender R. The Incidence and Prevalence of Uveitis in Psoriasis: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 24:601-607. [PMID: 32866042 DOI: 10.1177/1203475420952420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The systemic effects and comorbidities of psoriasis include ocular disorders, such as uveitis. Patients with psoriatic arthritis in particular have been demonstrated to have an elevated risk for developing uveitis. Presently, the risk of uveitis in psoriasis has yet to be fully elucidated and this systematic review seeks to address this gap. OBJECTIVE To examine the prevalence and incidence of uveitis in psoriasis patients compared to non-psoriasis patients. METHODS We conducted a systematic review search on MEDLINE, Embase, and CENTRAL electronic databases with no lower limit on year of publication. RESULTS Fourteen articles met our inclusion criteria, with a total of 234 143 psoriasis subjects. Two studies found that participants with severe psoriasis were at a greater risk of uveitis than those with mild psoriasis. A random-effects meta-analysis of the 3 studies, which reported risk of incidence of uveitis in psoriasis patients compared to non-psoriasis controls, found a pooled risk ratio of 1.29 (95% CI, 1.10-1.51), indicating an increased risk of uveitis in psoriasis. Three studies compared risk of uveitis in psoriatic arthritis with psoriasis-only participants, all finding that psoriatic arthritis was associated with a greater risk of uveitis. CONCLUSIONS In summary, our findings suggest that psoriasis is associated with an increased risk of uveitis, with or without psoriatic arthritis.
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Affiliation(s)
- Megan Lam
- 12362 Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Jeremy Steen
- 62703 Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Justin Di Lu
- 12362 Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Ronald Vender
- 3710 Department of Dermatology, McMaster University, Hamilton, ON, Canada
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13
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Abstract
Eye involvement in psoriasis is little known to many dermatologists, although psoriasis has been acknowledged as a systemic disease for decades. The ophthalmic complications of psoriasis are numerous and can affect almost any part of the eye. The most common ocular changes in patients with psoriasis, including blepharitis, conjunctivitis, keratitis, iridocyclitis, UV-induced cataracts, uveitis, and birdshot chorioretinitis, have been described in the literature. Recognition of the ocular complications of psoriasis is of significant clinical importance, because various pathogenic mechanisms may contribute to the development of ocular manifestations, including direct eye involvement with psoriatic plaques, psoriasis-related immune-mediated inflammatory processes, and complications of psoriasis treatments.
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Affiliation(s)
- Zdravka Demerdjieva
- Department of Dermatology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria.
| | - Iskra Mazhdrakova
- Department of Ophthalmology, Alexanders University Hospital, Sofia, Bulargia
| | - Nikolai Tsankov
- Department of Dermatology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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14
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Ngwasiri CA, Kwangsa NMC, Abanda MH, Aminde LN. Occurrence and challenges in the management of severe chronic plaque type psoriasis in a limited resourced setting: a case report. Pan Afr Med J 2019; 32:86. [PMID: 31223377 PMCID: PMC6561001 DOI: 10.11604/pamj.2019.32.86.13329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/18/2018] [Indexed: 11/21/2022] Open
Abstract
Plaque-type psoriasis is a major dermatosis with significant effects on quality of life. Case complexity is often high in low-resourced settings such as in Africa where the incidence has been on the rise. Despite major advancements and newer therapeutic modalities over the last decade, an insight into the real-life, day to day challenges in low resourced settings reveal an interplay between the difficulty in obtaining these drugs and use of alternative traditional indigenous agents. We report the case of a 50 year old immunocompetent male who presented with chronic and extensive well demarcated plaques covered with silver-white scales occupying about 61% of his body surface area. Patient was however lost to follow up for about 8 months during which time, the lesions responded to some unknown homemade indigenous medications which was preferred to a systemic medication. Paramount importance on proper counselling and the need to retain patients in care is warranted by physicians and allied health personnel. Also, incentives aimed at subsidizing the newer systemic agents for patients in low resourced cohorts will go a long way to combat this multi-faceted disorder which is often unrecognized and under diagnosed.
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Affiliation(s)
- Calypse Asangbe Ngwasiri
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.,Healing Touch Hospital, Muyuka, South-West Region, Cameroon
| | | | | | - Leopold Ndemnge Aminde
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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15
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Yamaguchi K, Hayashi T, Takahashi G, Momose M, Asahina A, Nakano T. Successful Certolizumab Pegol Treatment of Chronic Anterior Uveitis Associated with Psoriasis Vulgaris. Case Rep Ophthalmol 2018; 9:499-503. [PMID: 30687070 PMCID: PMC6341314 DOI: 10.1159/000495655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/21/2018] [Indexed: 01/25/2023] Open
Abstract
This report presents details on a 45-year-old male Japanese patient with chronic and refractory anterior uveitis associated with psoriasis vulgaris who was administered certolizumab pegol (CZP), which is an anti-tumor necrosis factor alpha (TNF-α) monoclonal antibody. Although CZP has only been formally approved for rheumatoid arthritis treatment in Japan, a clinical trial allowed us to assess CZP effectiveness in this patient. The grade 3+ anterior chamber inflammation (for both the cells and flare) observed at baseline improved to grade 0 at 3 months post-treatment. Dermatologically, the psoriasis area severity index (PASI) score was 25.4, while the body surface area (BSA) was 88% at baseline. At 3 months after treatment, the scores improved to 2.8 for PASI and less than 1% for BSA. After the treatment, remission has lasted for at least 9 months. No adverse events were seen during the CZP treatment. These findings suggest that CZP could be an effective therapeutic alternative in some refractory anterior uveitis patients with psoriasis vulgaris.
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Affiliation(s)
- Keiko Yamaguchi
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Takaaki Hayashi
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Genichiro Takahashi
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Mami Momose
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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Abstract
The relationship between the eye and psoriasis has been recognized for decades, but the precise eye manifestations in patients with psoriasis and psoriatic arthritis are only recently coming to light. Psoriatic eye findings may include conjunctivitis, dry eye, episcleritis, and uveitis, all of which may precede articular changes. Uveitis, seen in 7% to 25% of psoriatic arthritis patients, may be recognized by the presence of conjunctival injection, photophobia, pain, lid swelling, or otherwise unexplained visual changes. Early recognition is paramount because its natural course may lead to vision loss. Immunopathogenesis has shown evidence for T-helper cell (Th) type 1 (Th1) and Th17 involvement in the pathogenesis of uveitis according to the murine experimental autoimmune uveitis model. Corticosteroids are the primary treatment modality; however, increasing emphasis has been placed on immunomodulators and biologics for more intractable cases. Referral to an ophthalmologist is essential for definitive diagnosis and treatment.
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Affiliation(s)
- Shiu-chung Au
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Shimrat Yaniv
- Albert Einstein College of Medicine, New York, New York
| | - Alice B. Gottlieb
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
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18
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Rodríguez-Ausín P, Antolín-Garcia D, Ruano Del Salado M, Hita-Antón C. Topical tacrolimus 0.03% for the treatment of ocular psoriasis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:505-507. [PMID: 27130870 DOI: 10.1016/j.oftal.2016.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE/METHODS Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. RESULTS/CONCLUSIONS All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis.
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Affiliation(s)
- P Rodríguez-Ausín
- Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
| | - D Antolín-Garcia
- Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - M Ruano Del Salado
- Departamento de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - C Hita-Antón
- Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
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Sakurai Y, Namba K, Mizuuchi K, Nomura T, Ishida S. A Case of Severe Panuveitis Associated with Psoriasis Vulgaris Successfully Treated with Infliximab. Case Rep Ophthalmol 2016; 7:191-4. [PMID: 27239187 PMCID: PMC4881253 DOI: 10.1159/000445285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Uveitis associated with psoriasis vulgaris is usually seen as an anterior segment inflammation, and it is very rare that the inflammation extends to the posterior segment. We herein report a case of severe panuveitis associated with psoriasis vulgaris presenting as retinal neovascularization, leading to vitreous hemorrhages that were successfully treated with infliximab (IFX). Case Report A 27-year-old male with psoriasis vulgaris was referred to our hospital due to prolonged severe uveitis OU. He showed a severe anterior chamber inflammation with fibrin formation and total posterior iris synechia OU. With topical corticosteroid treatment, these conditions were relieved for a short time; however, the intraocular inflammation was exacerbated with vitreous hemorrhages caused by retinal neovascularization OS. After the administration of IFX therapy, the intraocular inflammation and retinal neovascularization was resolved, and so far, no severe recurrences have been seen for 3 years with the therapy. Conclusion When we see patients with severe panuveitis associated with psoriasis extending to the posterior segment, IFX treatment may be a good therapeutic option.
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Affiliation(s)
- Yuri Sakurai
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshihumi Nomura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Biologic therapy for refractory scleritis: a new treatment perspective. Int Ophthalmol 2015; 35:903-12. [DOI: 10.1007/s10792-015-0124-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/23/2015] [Indexed: 12/12/2022]
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21
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Sterile Corneal Infiltrates Secondary to Psoriasis Exacerbations: Topical Tacrolimus as an Alternative Treatment Option. Eye Contact Lens 2015. [PMID: 26222098 DOI: 10.1097/icl.0000000000000178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Psoriasis is a common chronic inflammatory skin disease. Ocular manifestations, which occur in 10% to 20% of cases of psoriasis, are usually bilateral and often present during an exacerbation of the psoriasis. Serious corneal involvement is rare but can be devastating. CASE REPORT Two cases of sterile corneal infiltrates secondary to an exacerbation of psoriasis are presented. Treatment involved the use of 0.02% topical tacrolimus ointment, which resulted in resolution of the symptoms and infiltrates. DISCUSSION AND CONCLUSION Topical tacrolimus may be considered as an alternative treatment option to corticosteroids in sterile corneal infiltrates.
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Clinical features of psoriatic uveitis in Japanese patients. Graefes Arch Clin Exp Ophthalmol 2015; 253:1175-80. [PMID: 25725620 DOI: 10.1007/s00417-015-2968-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the clinical features of psoriatic uveitis in Japanese patients. METHODS Clinical features of 13 consecutive patients with psoriatic uveitis treated at our facility were retrospectively examined using medical records. In this study, we collected data about psoriasis type, uveitis laterality, onset type, HLA types, visual acuity, ocular inflammation localization, anterior segment findings, funduscopy findings, complications, recurrence, and medical treatments for uveitis and skin diseases. RESULTS The cohort comprised ten males and three females (43.6 ± 7.1 years old), and types of psoriasis included psoriasis vulgaris (seven cases), psoriatic arthritis (four cases), pustular psoriasis (three cases) and psoriatic erythroderma (one case). Two cases represented complicated cases of pustular psoriasis and psoriatic arthritis. Seven cases were unilateral, and six cases were bilateral. All cases had acute non-granulomatous anterior uveitis, whereas panuveitis occurred in one case. Furthermore, macular edema and vascular leakage on fluorescein angiography occurred in four cases, and hyperemic disc occurred in two cases. Recurrence occurred in nine cases. In addition to topical corticosteroid treatment, eight cases underwent oral immunosuppressive treatment or biologics. All six cases undergoing HLA typing were HLA-A2 positive. CONCLUSIONS Cases of psoriatic uveitis in Japan appear to present with acute non-granulomatous uveitis; other symptoms may include macular edema, retinal vasculitis, or hyperemic disc.
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Fotiadou C, Lazaridou E, Kemanetzi C, Kyrmanidou E, Ioannides D. Recalcitrant psoriatic uveitis and anti-tumor necrosis factor-α monoclonal antibodies: experience from a psoriasis referral center. Int J Dermatol 2014; 54:1105-8. [PMID: 25557117 DOI: 10.1111/ijd.12744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of non-infectious uveitis on a background of psoriasis is estimated to be 7-20%. The use of tumor necrosis factor-α (TNF-α) inhibitors as a treatment for refractory uveitis is emerging. METHODS The psoriasis outpatient database at our referral center was searched for patients with concurrent diagnoses of psoriasis and uveitis. The medical records of the patients identified were reviewed for the use of TNF-α inhibitors. RESULTS Five patients (three women and two men) were identified. All of them suffered moderate to severe psoriasis and chronic, bilateral uveitis. The patient with the most severe ocular inflammation was the only patient positive for human leukocyte antigen B27 (HLA-B27) and the only one to suffer from psoriatic arthritis. All patients had received treatment with adalimumab and had been evaluated at three and six months. Their psoriasis had responded excellently, and in four patients, uveitis had shown the complete remission of inflammation at six months. The fifth patient (HLA-B27+) exhibited improved uveitis activity but not complete remission at six months. CONCLUSIONS Uveitis is an entity that should be considered when evaluating psoriasis patients with ocular complaints, even in the absence of arthritis. Anti-TNF-α monoclonal antibodies and adalimumab in particular seem to represent a promising therapeutic avenue for the treatment of refractory psoriatic uveitis. Larger randomized clinical trials are needed to confirm our conclusions.
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Affiliation(s)
- Christina Fotiadou
- First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Christina Kemanetzi
- First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Eirini Kyrmanidou
- First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Demetris Ioannides
- First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece
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Filev FS, Herbert VG, Lögering B, von Gruben V, Reich K, Klemm M. [Psoriasis-associated keratitis: case report]. Ophthalmologe 2014; 111:1201-3. [PMID: 25245022 DOI: 10.1007/s00347-014-3115-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psoriasis is a common skin disease, which is associated with multiple extracutaneous manifestations. This article presents a case report of a rare ocular manifestation of psoriasis; psoriasis-associated keratitis. In a 37-year-old man we could show that systemic immunomodulatory therapy led to a rapid improvement of the ocular symptoms.
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Affiliation(s)
- F S Filev
- UKE-Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Hummelsbütteler Kirchenweg 75, 22339, Hamburg, Deutschland,
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25
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Psoriasis beyond the skin surface: a pilot study on the ocular involvement. Int Ophthalmol 2014; 35:331-40. [DOI: 10.1007/s10792-014-9950-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/15/2014] [Indexed: 12/17/2022]
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26
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Herbert V, Lögering B, von Gruben V, Filev F, Klemm M, Reich K. Ulcerative keratitis in psoriasis: a rare variant of psoriatic ocular inflammatory disease. Br J Dermatol 2014; 170:746-8. [DOI: 10.1111/bjd.12686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V.G. Herbert
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
| | - B. Lögering
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
| | - V. von Gruben
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
| | - F. Filev
- Department of Ophthalmology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Klemm
- Department of Ophthalmology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Reich
- Dermatologikum Hamburg; Stephansplatz 5 20354 Hamburg Germany
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Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert Panel Recommendations for the Use of Anti–Tumor Necrosis Factor Biologic Agents in Patients with Ocular Inflammatory Disorders. Ophthalmology 2014; 121:785-96.e3. [DOI: 10.1016/j.ophtha.2013.09.048] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 12/14/2022] Open
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28
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Lee TH, Ji YS, Kim SJ, Yoon KC. A Case of Peripheral Ulcerative Keratitis and Scleritis in a Patient with Pustular Psoriasis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.6.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Hee Lee
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Jin Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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29
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Sánchez-Cano D, Callejas-Rubio JL, Ruiz-Villaverde R, Ríos-Fernández R, Ortego-Centeno N. Off-label uses of anti-TNF therapy in three frequent disorders: Behçet's disease, sarcoidosis, and noninfectious uveitis. Mediators Inflamm 2013; 2013:286857. [PMID: 23983404 PMCID: PMC3747407 DOI: 10.1155/2013/286857] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
Abstract
Tumoral necrosis factor α plays a central role in both the inflammatory response and that of the immune system. Thus, its blockade with the so-called anti-TNF agents (infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab) has turned into the most important tool in the management of a variety of disorders, such as rheumatoid arthritis, spondyloarthropatties, inflammatory bowel disease, and psoriasis. Nonetheless, theoretically, some other autoimmune disorders may benefit from these agents. Our aim is to review these off-label uses of anti-TNF blockers in three common conditions: Behçet's disease, sarcoidosis, and noninfectious uveitis. Due to the insufficient number of adequate clinical trials and consequently to their lower prevalence compared to other immune disorders, this review is mainly based on case reports and case series.
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30
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Ermertcan AT, Emre S, Öztürk F, Gençoğlan G, Gündüz K. Psoriatic uveitis responding to adalimumab therapy. Int J Dermatol 2013; 53:e271-3. [PMID: 23879868 DOI: 10.1111/ijd.12194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aylin Türel Ermertcan
- Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
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Kilic B, Dogan U, Parlak AH, Goksugur N, Polat M, Serin D, Ozmen S. Ocular findings in patients with psoriasis. Int J Dermatol 2013; 52:554-9. [PMID: 23330957 DOI: 10.1111/j.1365-4632.2011.05424.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease affecting skin, nails, and joints. Although there are not many reports in the literature, ocular findings occur in approximately 10% of patients, in mostly those who have psoriatic arthritis. In this study, we aimed to evaluate eye involvement in psoriasis patients. METHODS This study was performed on a total of 100 psoriasis patients and a group of 100 healthy individuals. History was taken from all study and control subjects, and dermatological, systemic, and ophthalmological examinations were performed and Schirmer and BUT values were measured. Constant variables were compared using the t-test, and categorical variables were compared using chi-square test. Relationship between ocular findings and sex, age, duration of psoriasis, PASI score, presence of psoriatic plaques on the eyelid, nail involvement, and psoriatic arthritis was evaluated using logistic regression analysis. Statistical analyses were performed individually for both right and left eyes. RESULTS The number of ocular findings in both eyes in the patient group was found to be statistically higher than that in the control group. Schirmer and BUT values were statistically lower in the patient group than those in the control group. CONCLUSIONS Although results of our study support the necessity of routine ophthalmological examination of psoriasis patients for early diagnosis and treatment, we believe that further studies are required on the etiopathogenesis of ocular involvement in psoriasis patients.
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Affiliation(s)
- Berna Kilic
- Department of Dermatology, Yozgat State Hospital, Yozgat, Turkey.
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32
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Cordero-Coma M, Yilmaz T, Onal S. Systematic Review of Anti-Tumor Necrosis Factor-alpha Therapy for Treatment of Immune-mediated Uveitis. Ocul Immunol Inflamm 2013; 21:19-27. [DOI: 10.3109/09273948.2012.723107] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Affiliation(s)
- Hoi Soo Yoon
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
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Heo J, Sepah YJ, Yohannan J, Renner M, Akhtar A, Gregory A, Shulman M, Do DV, Nguyen QD. The role of biologic agents in the management of non-infectious uveitis. Expert Opin Biol Ther 2012; 12:995-1008. [PMID: 22780091 DOI: 10.1517/14712598.2012.688021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Uveitis is an intriguing group of disorders characterized by inflammation of the uveal tract. Due to the potential grave consequences of the disease process, it is important to assess the various therapeutic options available for treating uveitis, and their outcomes. AREAS COVERED This review discusses the use of conventional agents in the management of uveitis, including discussion of the molecular and clinical properties of corticosteroids, antimetabolites, calcineurin inhibitors and alkylating agents and their side effects. In addition, it also discusses the molecular and clinical properties of novel biologic agents and their side effects. Moreover, recommendations as to when biologic agents should be employed are also discussed. EXPERT OPINION We recommend that in general (except in selected cases of Adamantiades-Behçet's disease) biologics should not be used as a first-line therapy for uveitis due to inconvenience, high cost, and potential immunosuppressive effects. However, many biologics are potent in inducing drug-free remission of uveitis and may be employed to manage recurrent diseases or diseases not responsive to conventional agents.
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Affiliation(s)
- Jangwon Heo
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Johns Hopkins Hospital, Retinal Imaging Research and Reading Center, 600 North Wolfe Street, Maumenee 745, Baltimore, MD 21287, USA
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Bawazeer AM, Raffa LH. Adalimumab in the treatment of recurrent idiopathic bilateral nodular scleritis. Oman J Ophthalmol 2012; 4:139-41. [PMID: 22279403 PMCID: PMC3263168 DOI: 10.4103/0974-620x.91271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Our objective is to report a case of bilateral nodular scleritis in a 34-year-old patient, resistant to steroids and traditional disease modifying anti-rheumatic drugs, who was successfully treated with subcutaneous injections of 40 mg adalimumab. Adalimumab resulted in rapid control of scleritis in both eyes within 3 months with no recurrence over 5 years of follow-up. No side effects were reported during treatment.Although a large prospective study and a longer follow-up are required to reach a conclusive result, adalimumab has a potential role in the treatment of the above condition with the control of inflammation.
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Affiliation(s)
- Ahmed M Bawazeer
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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36
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Sainz de la Maza M, Molina N, Gonzalez-Gonzalez LA, Doctor PP, Tauber J, Foster CS. Clinical Characteristics of a Large Cohort of Patients with Scleritis and Episcleritis. Ophthalmology 2012; 119:43-50. [DOI: 10.1016/j.ophtha.2011.07.013] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/29/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022] Open
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37
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Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI. Ocular psoriasis. J Am Acad Dermatol 2011; 65:1202-12. [DOI: 10.1016/j.jaad.2010.10.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 10/24/2010] [Accepted: 10/28/2010] [Indexed: 01/18/2023]
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38
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Sadowsky AE. Dermatologic Disorders and the Cornea. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
IMPORTANCE OF THE FIELD The term 'uveitis' covers a broad spectrum of ocular inflammation affecting the iris, ciliary body, and/or the choroid, all of which comprise the uveal tract. Severe cases of uveitis need be treated aggressively to prevent damage caused by chronic inflammation. Untreated or poorly managed cases can lead to ciliary body dysfunction, inadequate aqueous production, chorioretinal damage, and possibly blindness. AREAS COVERED IN THIS REVIEW There are many medications that can be used to treat uveitis. Corticosteroids are available in several formulations: topical drops, regional injections, oral and intravenous. Immunomodulatory agents that can be used for uveitis are antimetabolites, T-cell inhibitors, alkylating agents, and biologic response modifiers. These medications, their appropriate uses, and side effect monitoring will be detailed. WHAT THE READER WILL GAIN There is a stepladder approach to treatment of ocular inflammation. Corticosteroids are the treatment of choice for treating acute flares. Steroid free remission is the goal of therapy and can be achieved with the use of chemotherapeutic agents. Which medications are appropriate and how to escalate therapy will be reviewed. TAKE HOME MESSAGE Chronic systemic corticosteroid therapy is not an acceptable long treatment plan for uveitis, unless all other medications have failed. Steroid sparing immunosuppressive therapy should be pursued as soon as acute flares of uveitis have been controlled.
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Affiliation(s)
- Frank F Lee
- Massachusetts Eye Research and Surgery Institution, 5 Cambridge Center, 8th Floor, Cambridge, MA 02142, USA
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Kodama N, Mizuno S, Nanba H, Saito N. Potential Antitumor Activity of a Low-Molecular-Weight Protein Fraction from Grifola frondosa Through Enhancement of Cytokine Production. J Med Food 2010; 13:20-30. [DOI: 10.1089/jmf.2009.1029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Noriko Kodama
- Laboratory of Molecular Pharmacology, Biosignal Research Center, Kobe University, Kobe, Japan
- Department of Basic Educational Center for Pharmacy, Kobe Pharmaceutical University, Kobe, Japan
| | - Shigeto Mizuno
- Department of Medical Pharmaceutics, Kobe Pharmaceutical University, Kobe, Japan
| | | | - Naoaki Saito
- Laboratory of Molecular Pharmacology, Biosignal Research Center, Kobe University, Kobe, Japan
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Díaz-Lagares C, Belenguer R, Ramos-Casals M. [Systematic review on the use of adalimumab in autoinmune. Efficacy and safety in 54 patients]. ACTA ACUST UNITED AC 2010; 6:121-7. [PMID: 21794697 DOI: 10.1016/j.reuma.2009.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 06/04/2009] [Accepted: 06/10/2009] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To analyze published evidence about adalimumab use in autoimmune diseases. METHODS Systematic review of MEDLINE database of citations included from January 1990 to December 2008 employing the terms "adalimumab" and the different systemic autoimmune diseases. RESULTS Our search identified 241 potentially relevant citations. 154 were retrieved for detailed evaluation. Finally, 18 were selected as relevant, including 54 patients. The reported diseases were as follow: Behçet disease in 16 patients, idiopathic uveitis in 13, sarcoidosis in 5, uveitis associated with rheumatologic diseases in 5 (psoriasis in 2, ankylosing spondylitis in 1, juvenile idiopathic arthritis in 1, Crohn disease in 1), Vogt-Koyanagi-Harada disease in 4, Birdshot uveitis in 4, vasculitis in 3 (1 temporal arteritis, 1 Takayasu's disease, 1 skin vasculitis associated with rheumatoid arthritis), adult onset Still disease in 2, relapsing polychondritis in 1 and systemic sclerosis in 1. The clinical spectrum included uveitis (39 cases), skin and/or mucosae (9), vasculitis (3), arthritis (6), lung (3). These patients were refractory to standard therapy, including corticosteroids (42 cases, 78%), immunosuppressants (42, 78%) and biologics (29, 54%). Fifty (93%) patients responded to adalimumab. The clinical response was similar in those patients who had been treated with other biologic and in those who had not received biologic therapy before adalimumab. The patients were followed for 11.9 months. Twelve (22%) patients relapsed. Five (9%) patients suffer some side effect (3 local skin reaction, 1 angioedema, 1 lung fibrosis). One patient (2%) died due to progression of her disease. CONCLUSIONS Available data about the use of adalimumab in autoinmune diseases come from case reports and uncontrolled studies, that include patients with severe disease and refractory to standard therapy. In this setting, it seems to be an effective and safe treatment option, especially in patients with uveitis and Behçet's disease. This initial data must be confirmed by controlled assays before extending adalimumab use.
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Affiliation(s)
- Cándido Díaz-Lagares
- Laboratorio de Enfermedades Autoinmunes Josep Font, Servicio de Enfermedades Autoinmunes, IDIBAPS, Hospital Clinic, Barcelona, España
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