Clinical features and predictive factors in psoriatic arthritis-related uveitis.
OBJECTIVE
To analyze the clinical features of uveitis in psoriatic arthritis (PsA) and to investigate the factors predicting its appearance.


METHODS
Retrospective cohort study (1991-2000) of 71 patients diagnosed with PsA according to the criteria of Moll and Wright. All patients were studied according to a standard protocol. The group was divided into 3 articular categories: axial, oligoarticular, and polyarticular. Human leukocyte antigen (HLA)-Cw typing was performed by the polymerase chain reaction-sequence specific oligonucleotide probes (PCR-SSOP) method in 65 patients and in 177 healthy donors. HLA-DR typing was done by serologic methods in the 71 patients and in 82 healthy donors from the same racial and geographic origin. The HLA-B27 allele also was tested among the study population. All subjects with possible inflammatory ocular disease received a complete ophthalmologic examination at the Ophthalmology Department of our hospital. Only patients with uveitis were analyzed. Univariate and multivariate analyses were applied.


RESULTS
Thirteen patients had uveitis (18% of this series), 4 (31%) had an insidious onset, and the remaining had acute-onset uveitis. Five cases (39%) had bilateral-simultaneous uveitis. Ten (77%) presented with anterior uveitis only, 2 with anterior and posterior pole involvement, and only 1 case with isolated posterior pole involvement. Four patients needed oral corticosteroids; 2 of them also used immunosuppresive drugs. None of our patients developed sequelae or complications. In univariate analysis, uveitis was associated with inflammatory back pain (P =.02), sacroiliac pain (P =.001), syndesmophytes (P =.001), bilateral sacroileitis (P =.0001), HLA-DR13 (P =.002), and HLA-B27 (P =.026). In multivariate analysis, the predictive factors for uveitis were bilateral sacroileitis (OR 17, 95% CI: 3.7-76, P =.0002), HLA-DR13 (OR 24, 95% CI: 3.78-150, P =.0056), and syndesmophytes (OR 9.7, 95% CI: 0.97-97, P =.05).


CONCLUSIONS
Insidious onset, bilaterality, posterior pole involvement, and chronicity are common in PsA patients with uveitis. In this study, extensive axial involvement (bilateral sacroileitis and syndesmophytes), and the HLA-DR13 antigen were the best predictors for the appearance of uveitis.
Queiro
Rubén
R
Rheumatology Service and Ophthalmology Service, Complejo Hospitalario Donostia (CHDO), San Sebastian-Guipúzcoa, Basque Country-Spain. ruquei@mixmail.com
Torre
Juan C
JC
Belzunegui
Joaquín
J
González
Carlos
C
De Dios
Juan R
JR
Unanue
Francisco
F
Figueroa
Manuel
M
D015535:Arthritis, Psoriatic / Q000150:complications*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis; D059810:HLA-DR Serological Subtypes; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012446:Sacroiliac Joint; D014605:Uveitis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology
D006684:HLA-DR Antigens; D059810:HLA-DR Serological Subtypes; C097337:HLA-DR13 antigen