TY - JOUR
T1 - Uveitis and Juvenile Psoriatic Arthritis or Psoriasis
AU - Salek, Sherveen S.
AU - Pradeep, Archana
AU - Guly, Catherine
AU - Ramanan, Athimalaipet V.
AU - Rosenbaum, James T.
N1 - Funding Information:
We have characterized the uveitis in 6 children with psoriasis or psoriatic arthritis who were managed either in Oregon or in England. Five of the 6 children developed eye, skin, and/or joint disease that began at age 6 or earlier. Most had bilateral eye disease that was vision threatening and often had complications such as glaucoma. All required biologic therapy. Ophthalmic surgery in these children was frequent. One of our patients was HLA-B27 positive. All of the patients except 1 had objective joint disease, 5 with pauciarticular, asymmetric disease. We included the patient without joint disease in this series because psoriasis is less common in childhood than in adults, and it is especially uncommon in male individuals at a very young age. 11 Furthermore, the behavior of his eye disease fits well with the others reported in this series and he did experience arthralgias, although the consulting pediatric rheumatologist did not find objective evidence for joint swelling. Because both centers are referral centers, patients with more severe eye and joint disease tend to be seen. Thus, we cannot absolutely confirm the observation from the recent CARRA study that uveitis is more common in children with psoriatic arthritis and an early age of onset. However, our data strongly suggest that children with early-onset arthritis and psoriasis are at risk for a severe form of uveitis. We conclude this because the CARRA study shows that psoriatic arthritis is more than 3 times as common in the older age group, whereas 5 of our 6 children in this series of children with psoriasis, arthritis, and uveitis had disease that began at age 6 or younger. Our characterization of uveitis in association with psoriatic arthritis in children reveals distinctions from the uveitis noted in adults with psoriatic arthritis. None of the children in this series had axial joint disease, for example. And none of them had unilateral, acute anterior uveitis, as is characteristic of HLA-B27-associated disease and is also seen in a subset of adults with psoriatic arthritis. 6 Our observations support the hypothesis that juvenile psoriatic arthritis has at least 2 distinct subsets, 1 with an onset at age 6 or before and 1 with an age of onset around age 11. The small size of our series is such that our conclusions should be validated by observations from other centers. We suggest, however, that distinct subsets of disease should correlate with unique aspects of pathogenesis and ultimately with therapy tailored to this pathogenesis. The differential diagnosis of arthritis associated with psoriasis is extensive. It includes ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, Behçet disease, pauciarticular early-onset juvenile idiopathic arthritis, Kawasaki disease, sarcoidosis, Blau syndrome, systemic lupus erythematosus, Sweet syndrome, and even infections such as Lyme disease or Whipple disease. Our observations suggest that early-onset juvenile psoriatic arthritis should be added to this list as an entity that is distinct from other forms of psoriatic arthritis. Funding/Support: This work was supported by the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. This work was supported in part by NIH Grant RO1 EY026572 to Dr. Rosenbaum. Financial Disclosures: Sherveen S. Salek has received travel support from Abbvie. Athimalaipet V. Ramanan has received speaking or consultant fees from Abbvie, SOBI, Eli Lilly, Sanofi, Regeneron, and UCB. James T. Rosenbaum receives consulting or speaking fees from Abbvie, Gilead, Regeneron, UCB, Eyevensys, Cavtherx, Santen, and Topivert. He has received research support from Alcon Research Institute and the National Institutes of Health. Catherine Guly has been served as a consultant for Abbvie. The following author have no financial disclosures: Archana Pradeep. All authors attest that they meet the current ICMJE criteria for authorship.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - Purpose To describe the phenotype of the uveitis that accompanies juvenile psoriatic arthritis or psoriasis. Design Observational case series. Methods SETTING: Two university-based referral clinics: 1 in England, 1 in the United States. STUDY POPULATION: Five children with uveitis and psoriatic arthritis and 1 with uveitis and psoriasis OBSERVATIONAL PROCEDURE: Retrospective chart review. MAIN OUTCOME MEASURES: Demographics of subjects such as age and sex; description of ocular and joint disease; surgical and other complications; medical treatment. Results Five of the 6 children in this series had the onset of disease at or before age 6 (P =.0008 compared to expected age of onset for psoriatic arthritis in childhood). All children in this series had an inadequate response to topical corticosteroids. Most of the children were treated with systemic corticosteroids for many months, yet all of them went on to require methotrexate. Therapy with systemic methotrexate did not suffice, as all the patients also required some form of biologic therapy. Five of 6 had surgeries such as vitrectomy, cataract extraction, or a procedure for glaucoma control. Conclusions The observations suggest that the uveitis that accompanies juvenile psoriatic arthritis might be a distinct disease that is particularly severe when its onset affects children aged 6 years or younger.
AB - Purpose To describe the phenotype of the uveitis that accompanies juvenile psoriatic arthritis or psoriasis. Design Observational case series. Methods SETTING: Two university-based referral clinics: 1 in England, 1 in the United States. STUDY POPULATION: Five children with uveitis and psoriatic arthritis and 1 with uveitis and psoriasis OBSERVATIONAL PROCEDURE: Retrospective chart review. MAIN OUTCOME MEASURES: Demographics of subjects such as age and sex; description of ocular and joint disease; surgical and other complications; medical treatment. Results Five of the 6 children in this series had the onset of disease at or before age 6 (P =.0008 compared to expected age of onset for psoriatic arthritis in childhood). All children in this series had an inadequate response to topical corticosteroids. Most of the children were treated with systemic corticosteroids for many months, yet all of them went on to require methotrexate. Therapy with systemic methotrexate did not suffice, as all the patients also required some form of biologic therapy. Five of 6 had surgeries such as vitrectomy, cataract extraction, or a procedure for glaucoma control. Conclusions The observations suggest that the uveitis that accompanies juvenile psoriatic arthritis might be a distinct disease that is particularly severe when its onset affects children aged 6 years or younger.
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U2 - 10.1016/j.ajo.2017.10.018
DO - 10.1016/j.ajo.2017.10.018
M3 - Article
C2 - 29101009
AN - SCOPUS:85033792887
SN - 0002-9394
VL - 185
SP - 68
EP - 74
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
ER -