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Oliveira RDC, Faneli AC, Amaral DC, Chagas JM, Guedes J, Follador I, de Oliveira MDFSP, Fernandes BF, Correia LCL. Ocular complications in adults with psoriasis: a cross-sectional study in a referral center in Brazil. Int Ophthalmol 2024; 44:215. [PMID: 38705919 PMCID: PMC11070383 DOI: 10.1007/s10792-024-03147-0] [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: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE There is limited literature on the ocular manifestations in patients with psoriasis. Therefore, this study aimed to identify the prevalence of and factors associated with ocular manifestations in adults with psoriasis. METHODS This cross-sectional study included Brazilian adults with psoriasis. The dermatological evaluation included diagnosis, clinical form, Psoriasis Area and Severity Index (PASI) measurement, and location of the lesions. Patients underwent a full ophthalmological examination, including the Schirmer I test, Rose Bengala staining, and tear breakup time tests. The results were analyzed using chi-square and Pearson's linear correlation tests. RESULTS Of the 130 patients assessed, 118 (90.8%) exhibited ocular abnormalities, with meibomian gland dysfunction (MGD) being the most prevalent (59.2%), followed by dry eye disease (DED) (56.2%). A significant correlation was observed between MGD and PASI (p = 0.05), and between MGD and certain treatment modalities. DED was significantly associated with PASI (p < 0.05). Concurrent use of acitretin was identified as an independent predictor of MGD (odds ratio [OR] = 3.5, p < 0.05), whereas PASI was a protective factor against DED (OR = 0.39, p < 0.01). CONCLUSION Given the high prevalence of eye disease among individuals with psoriasis, routine ophthalmological assessments are recommended to prevent possible ocular complications.
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Affiliation(s)
| | - Adriano Cypriano Faneli
- Bahiana School of Medicine and Public Health, Rua Machado Neto, 129, Pituba, Salvador, Bahia, CEP 41830-510, Brazil.
| | - Dillan Cunha Amaral
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jaime Guedes
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ivonise Follador
- University Hospital Complex Professor Edgard Santos (HUPES) - Federal University of Bahia, Salvador, Brazil
| | | | | | - Luis Claudio Lemos Correia
- Bahiana School of Medicine and Public Health, Rua Machado Neto, 129, Pituba, Salvador, Bahia, CEP 41830-510, Brazil
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Hijazi N, Gazitt T, Haddad A, Elias M, Kassem S, Feldhamer I, Cohen AD, Sar S, Tomkins-Netzer O, Saliba W, Zisman D. The risk factors for uveitis among psoriatic arthritis patients: a population-based cohort study. Clin Rheumatol 2024; 43:1053-1061. [PMID: 38082206 DOI: 10.1007/s10067-023-06834-y] [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: 07/05/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To assess the frequency of uveitis in patients with psoriatic arthritis (PsA) in the era of biologics and to identify risk factors associated with uveitis. METHODS A retrospective matched cohort study was conducted within the database of a large healthcare provider. Newly diagnosed 6147 adult PsA patients between 2005 and 2020 were matched by the index date of PsA diagnosis, age, sex, and ethnicity to 23,999 randomly selected controls. This cohort was used to examine the association between PsA and uveitis. An additional analysis was conducted within the PsA group to identify uveitis risk factors, using two analytic approaches: a retrospective cohort study and a nested case-control study. RESULTS Uveitis was diagnosed in 107 patients in the PsA group (1.7%) vs 187 (0.8%) patients in the control group (adjusted HR, 2.38, 95% CI 1.80-3.15, p<0.005) and was similar when the analysis was confined to patients without past uveitis. Uveitis was diagnosed more in females (2.1% vs 1.3%, HR 1.61, 95% CI 1.09-2.40, p<0.05), and was acute in all cases. Anterior uveitis was documented in 41.1% of the cases, 64.5% unilateral, and 9.3% bilateral. In the PsA group, using nested case control approach, only past uveitis [adjusted OR 136.4 (95% CI 27.38-679.88), p<0.005] and treatment with etanercept [adjusted OR 2.57 (95% CI 1.45-4.57), p=0.001] were independently associated with uveitis. Only one PsA patient with uveitis (out of 107) required systemic oral treatment with prednisone, while the rest of the patients were treated with topical glucocorticosteroids only. CONCLUSION PsA is associated with increased risk of uveitis. Past uveitis and treatment with etanercept were associated with higher risk of uveitis. Key Points • Psoriatic arthritis (PsA) is a major risk factor for uveitis with hazard ratio of 2.38 compared to healthy individuals without PsA. • Among PsA patients, the past event of uveitis and treatment with etanercept are risk factors for uveitis. • Uveitis in patients treated with biologics for their PsA requires topical therapy only in most of the cases.
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Affiliation(s)
- Nizar Hijazi
- Department of medicine A and Rheumatology Unit, Carmel Medical Center, Michal 7 St., 3436212, Haifa, Israel.
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- Division of Rheumatology, University of Washington Medical Center, Seattle, USA
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Sameer Kassem
- Department of medicine A, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Feldhamer
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Arnon Dov Cohen
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shaul Sar
- Opthalmology department, Carmel Medical Center, Haifa, Israel
| | | | - Walid Saliba
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Fragoulis GE, Papagoras C, Gazi S, Mole E, Krikelis M, Voulgari PV, Kaltsonoudis E, Koletsos N, Katsimpri P, Boumpas D, Katsifis D, Kougkas N, Dimitroulas T, Sfikakis PP, Tektonidou MG, Gialouri C, Bogdanos DP, Simopoulou T, Koutsianas C, Mavrea E, Katsifis G, Kottas K, Konsta M, Tziafalia M, Kataxaki E, Kalavri E, Klavdianou K, Grika EP, Sfontouris C, Daoussis D, Iliopoulos G, Bournazos I, Karokis D, Georganas K, Patrikos D, Vassilopoulos D. Disease Profile and Achievement of Therapeutic Goals in a Modern, Nationwide Cohort of 923 Patients with Psoriatic Arthritis. Mediterr J Rheumatol 2023; 34:418-426. [PMID: 38282940 PMCID: PMC10815515 DOI: 10.31138/mjr.301223.dpa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
Background Psoriatic arthritis (PsA) is a heterogenous chronic inflammatory disease affecting skin, joints, entheses, and spine with various extra-musculoskeletal manifestations and comorbidities. The reported patient, disease and treatment characteristics in the modern therapeutic era are limited. Methods In this cross-sectional, multi-centre, nationwide study, we recorded the demographic, clinical, and therapeutic characteristics as well as the comorbidities of patients with PsA seen for 1 year (1/1/2022-31/12/2022). Results 923 patients (55% females) with a median (IQR) age of 57 (48-65) years and a mean disease duration of 9.5 years were enrolled. Family history of psoriasis and PsA was noted in 28.3% and 6.3%, respectively. Most patients had limited psoriasis (BSA<3: 83%) while enthesitis, dactylitis, nail and axial involvement reported in 48.3%, 33.2%, 43% and 25.9% of patients, respectively. Regarding comorbidities, approximately half of patients had dyslipidaemia (42%) or hypertension (45.4%), 36.8% were obese and 17% had diabetes while 22.7% had a depressive disorder. Overall, 60.1% received biologics and among them more patients treated with anti-IL-17 or -12/23 agents were on monotherapy (64.2%) compared to those on TNFi monotherapy (49.4%, p=0.0001). The median PsA activity as assessed by the DAPSA score was 6 (IQR: 2.3 - 13.1) with 46% of patients reaching minimal disease activity status (MDA). Conclusion In this large, real life, modern cohort of patients with PsA with frequent comorbidities who were treated mainly with biologics, almost half achieved minimal disease activity. These results show the value of existing therapeutic approaches while at the same time highlight the existing unmet needs.
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Affiliation(s)
- George E. Fragoulis
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sousana Gazi
- Department of Rheumatology, KAT Hospital, Athens, Greece
| | - Evangelia Mole
- Department of Rheumatology, KAT Hospital, Athens, Greece
| | | | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Evripidis Kaltsonoudis
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nikolaos Koletsos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Pelagia Katsimpri
- Joint Academic Rheumatology Program, 4 Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Boumpas
- Joint Academic Rheumatology Program, 4 Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Katsifis
- Joint Academic Rheumatology Program, 4 Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Kougkas
- 4 Department of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Petros P. Sfikakis
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G. Tektonidou
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Gialouri
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece
| | - Theodora Simopoulou
- Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece
| | - Christos Koutsianas
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology Unit, 2 Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - Eugenia Mavrea
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology Unit, 2 Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - Gkikas Katsifis
- Rheumatology Clinic, Naval Hospital of Athens, Athens, Greece
| | | | - Maria Konsta
- Rheumatology Unit, Sismanoglio Hospital, Athens, Greece
| | | | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | - Eleni Kalavri
- Department of Rheumatology, “Asklepieion” General Hospital, Athens, Greece
| | | | - Eleftheria P. Grika
- Department of Rheumatology, Evaggelismos Athens General Hospital, Athens, Greece
| | | | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - George Iliopoulos
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | | | | | | | | | - Dimitrios Vassilopoulos
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology Unit, 2 Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
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Kougkas N, Magiouf K, Gialouri CG, Evangelatos G, Pappa M, Dimouli A, Iliopoulos A, Karmanakos A, Dimitroulas T, Tektonidou MG, Sfikakis PP, Fragoulis GE. Higher frequency but similar recurrence rate of uveitis episodes in axial spondylarthritis compared to psoriatic arthritis. A multicentre retrospective study. Rheumatol Int 2023; 43:2081-2088. [PMID: 37610650 PMCID: PMC10495278 DOI: 10.1007/s00296-023-05424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND/OBJECTIVE Data on risk factors predicting uveitis development in spondyloarthritis (SpA) is scarce. Our aim was to examine associations between demographic, clinical and/or laboratory characteristics of SpA with the occurrence and the course of uveitis, including ocular damage and recurrence rate. METHODS Characteristics (at disease diagnosis and ever-present) from axSpA and Psoriatic arthritis (PsA) patients followed in 3 tertiary rheumatology-clinics were retrospectively recorded. Comparisons were made between patients with and without uveitis, as well as between those with uveitis-rate [episodes/year] above the median uveitis-rate in the whole cohort ("recurrent"-uveitis) and the remaining uveitis patients ("non-recurrent uveitis"). In multivariable models, age, gender and variables significantly different in univariate analyses were included. RESULTS 264 axSpA and 369 PsA patients were enrolled. In axSpA, uveitis occurred in 11.7% and was associated with HLA-B27 (OR = 4.15, 95%CI 1.16-14.80, p = 0.028) and ever-present peripheral arthritis (OR = 3.05 (1.10-8.41, p = 0.031). In contrast, uveitis in PsA occurred only in 2.7% of patients and was associated with SpA family-history (OR = 6.35 (1.29-31.27), p = 0.023) axial disease at diagnosis (OR = 5.61 [1.01-28.69], p = 0.038) and disease duration (OR = 1.12 [1.04-1.21], p = 0.004). Median uveitis recurrence rate was comparable between axSpA and PsA (0.205 and 0.285 episodes/year, respectively). No associations were found between recurrent uveitis and demographic/clinical/laboratory characteristics. Ocular damage (e.g. synechiae) was seen in 16.1% of axSpA and 30% of PsA patients, all of them with recurrent uveitis. CONCLUSION Uveitis occurred more commonly in axSpA than in PsA patients, while uveitis recurrence rate was similar. Permanent ocular damage may occur more often in PsA than axSpA.
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Affiliation(s)
- Nikolaos Kougkas
- Department of Rheumatology, Ippokration Hospital, Thessaloniki, Greece
| | - Konstantina Magiouf
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula G. Gialouri
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology unit, Second Department of Medicine and Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Pappa
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Dimouli
- Department of Rheumatology, “Evangelismos” General Hospital, Athens, Greece
| | - Alexios Iliopoulos
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology unit, Second Department of Medicine and Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Maria G. Tektonidou
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P. Sfikakis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George E. Fragoulis
- Joint Academic Rheumatology Program, First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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5
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Triggianese P, Fatica M, Caso F, Costa L, D'Antonio A, Tasso M, Greco E, Conigliaro P, Bergamini A, Fabiani C, Cantarini L, Chimenti MS. Rheumatologist's Perspective on Non-Infectious Uveitis: Patterns from Tertiary Referral Rheumatologic Clinics in Italy. Int J Mol Sci 2023; 24:ijms24119690. [PMID: 37298638 DOI: 10.3390/ijms24119690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Non-infectious uveitis (NIU) can be an early or even the first extra-articular manifestation of systemic rheumatic diseases, or the first one; thus, rheumatologists are often involved in the diagnostic and therapeutic assessment of NIU. We evaluated 130 patients with a diagnosis of NIU who were admitted to two Italian rheumatologic clinics (Tor Vergata University Hospital in Rome, and Federico II University in Naples) from January 2018 to December 2021. Anterior uveitis (AU) occurred in 75.4% of patients, followed by posterior uveitis (PU, 21.5%); acute (54.6%) and recurrent (35.4%) NIU were more documented than chronic NIU (10%), and a bilateral involvement was observed in 38.7% of cases. Half of NIU cases were associated with spondyloarthritis (SpA); the remaining were affected by Behçet disease (BD)-related uveitis (13.9%) and idiopathic NIU (9.2%). HLA-B27+ patients (34.8%) had a higher prevalence of anterior and unilateral NIU (p = 0.005) with acute course (p = 0.04) than HLA-B27- patients. On the contrary, HLA-B51+ patients (19.6%) had mostly PU and bilateral NIU (p < 0.0001) and recurrent course (p = 0.04) than HLA-B51- patients. At the first rheumatologic referral, 117 patients (90%) received systemic treatments. Findings from this study demonstrate that rheumatologic referral has a pivotal role in the diagnostic work-up of NIU and may dramatically influence NIU-treatment strategies.
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Affiliation(s)
- Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Mauro Fatica
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Luisa Costa
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Arianna D'Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Tasso
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Elisabetta Greco
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Alberto Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behcet's Disease Clinic, University of Siena, 53100 Siena, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
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