Risk of Uveitis Among People With Psoriasis: A Nationwide Cohort Study

Question  Do people with psoriasis have an increased risk of incident uveitis?

Findings  In this cohort study including 147 954 participants with psoriasis and 147 954 nonpsoriatic controls from Taiwan, people with concurrent severe psoriasis and psoriatic arthritis had the greatest risk of developing incident uveitis, followed by those with severe psoriasis but without psoriatic arthritis and those with mild psoriasis and psoriatic arthritis. There was not an increased risk for incident uveitis with mild psoriasis but without psoriatic arthritis.

Meaning  The risk of incident uveitis differs with different inflammatory presentations on the spectrum of psoriatic disease.

Importance  Uveitis has been associated with psoriatic arthritis, but to our knowledge, the relationship between uveitis and psoriasis is unsettled among researchers.

Objective  To evaluate the risk of incident uveitis among people with psoriasis.

Design, Setting, and Participants  This nationwide, retrospective cohort study conducted in Taiwan from January 1, 2000, to December 31, 2012 included 147 954 people with psoriasis (including 10 107 with concomitant psoriatic arthritis and 137 847 without psoriatic arthritis) and 147 954 nonpsoriatic controls.

Exposure  Psoriasis.

Main Outcomes and Measures  Risk of incident uveitis.

Results  The mean (SD) age of the 295 908 study participants was 44.4 (19.8) years, and 41.2% (n = 121 878) were women. We found that the group with severe psoriasis with psoriatic arthritis had the greatest risk of incident uveitis compared with the nonpsoriatic controls (adjusted hazard ratio, 2.40; 95% CI, 1.90-3.02). The group with severe psoriasis without psoriatic arthritis and the group with mild psoriasis with psoriatic arthritis also had an increased risk of incident uveitis (adjusted hazard ratio, 1.42; 95% CI, 1.23-1.64; and 1.42; 95% CI, 1.03-1.96; respectively). However, an increased risk for incident uveitis with mild psoriasis without psoriatic arthritis was not identified (adjusted hazard ratio, 1.09; 95% CI, 1.00-1.20).

Conclusions and Relevance  People with severe psoriasis and those with mild psoriasis have an increased risk of uveitis. Clinicians may use this finding as a guide for uveitis risk stratification among patients with different inflammatory presentations on the spectrum of psoriatic disease.