Psoriasis乾癬患者應檢查葡萄膜炎, 因發病率高且難治

林口長庚醫學中心 眼科部 視網膜與葡萄膜炎主任 黃奕修

原文出處 : 2015 JAMA dermatology.

經計算, 這表示乾癬病患得到葡萄膜炎的機率較平常人增加38%
如果病人合併乾癬關節炎, 得葡萄膜炎的機率更高至150%

A newly identified bidirectional association between psoriatic disease and uveitis has led researchers to suggest that patients with psoriasis and psoriatic arthritis should be closely evaluated for eye symptoms. Likewise, patients with prior or current uveitis should be closely evaluated for skin and joint symptoms.Alexander Egeberg, MD, from the University of Copenhagen in Denmark, and colleagues published the results of their nationwide cohort study online July 29 in JAMA Dermatology. The nationwide data collected from January 1, 1997, to December 3, 2011, allowed the investigators to evaluate a large number of patients with reduced selection bias.

The incidence rates (IR) for uveitis were 2.02 per 10,000 person-years among those with no psoriasis (95% confidence interval [CI], 1.99 – 2.06) compared with 2.88 among those with mild psoriasis (95% CI, 2.33 – 3.56), 4.23 for those with severe psoriasis (95% CI, 2.40 – 7.45), and 5.49 for those with psoriatic arthritis (95% CI, 3.36 – 8.96).

After adjusting for age, sex, socioeconomic status, and comorbidities, there was a 38% increased risk of uveitis among individuals with mild psoriasis (incidence rate ratio [IRR], 1.38;P = .02), a 40% increase among those with severe psoriasis (IRR, 1.40; P = .34), and a 150% elevation among those with psoriatic arthritis (IRR, 2.50; P < .001). The investigators suggest that the nonsignificant increase among those with severe psoriasis may be a result of the small number of events in this group (n = 12).

When the researchers analyzed the database from the perspective of patients with uveitis, the adjusted model also showed a relative increased risk for psoriasis. Specifically, individuals with uveitis had a 59% increased risk for mild psoriasis (IRR, 1.59; 95% CI, 1.32 – 1.91; P < .001), a greater than twofold increase in risk for severe psoriasis (IRR, 2.17; 95% CI, 1.40 – 3.38; P < .001), and a nearly fourfold increase for psoriatic arthritis (IRR, 3.77; 95% CI, 2.66 – 5.34; P < .001).

The study is the first to examine the bidirectional relationship between psoriasis and psoriatic arthritis and uveitis.

The study was funded by a grant from Pfizer. Dr Egeberg is employed by Pfizer. One coauthor is employed by Eli Lilly and Company. The other authors have disclosed no relevant financial relationships.

JAMA Dermatol. Published online July 29, 2015. Full text

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