Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark2The Danish Heart Foundation, Copenhagen, Denmark3National Institute of Public Health, University of Southern Denmark, Copenhagen.
JAMA Dermatol. 2015 Nov;151(11):1200-5. doi: 10.1001/jamadermatol.2015.1986.
Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. Limited evidence is available about the relationship between psoriatic disease and uveitis.
To investigate the potential bidirectional relationship between psoriatic disease, including psoriasis and psoriatic arthritis, and uveitis.
DESIGN, SETTING, AND PARTICIPANTS: We performed a nationwide cohort study of the Danish population from January 1, 1997, through December 31, 2011. We included 74,129 Danish patients with psoriasis who were 18 years or older during the study period. Patients were identified through administrative registries, and information on age, sex, socioeconomic status, medication, and comorbidity was obtained using individual-level linkage of administrative registers. We performed data analysis from January 27 through March 4, 2015.
Diagnosis of mild or severe psoriasis or psoriatic arthritis for uveitis risk and diagnosis of uveitis for the risk for psoriasis or psoriatic arthritis.
Diagnosis of uveitis, mild psoriasis, severe psoriasis, or psoriatic arthritis. We calculated incidence rates (IRs) and estimated IR ratios adjusted for potential confounders using Poisson regression.
We identified 74,129 cases of psoriasis and psoriatic arthritis and 13,114 cases of uveitis. The IRs (95% CIs) for uveitis were 2.02 (1.99-2.06), 2.88 (2.33-3.56), 4.23 (2.40-7.45), and 5.49 (3.36-8.96) for the reference population and those with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. In the reference population, these IRs (95% CIs) were 9.37 (9.30-9.45), 1.12 (1.10-1.15), and 1.04 (1.01-1.06), and in patients with uveitis, these statistics were 15.51 (12.92-18.62), 2.66 (1.72-4.13), and 4.25 (3.00-6.01) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Adjusted IR ratios (95% CIs) for uveitis were 1.38 (1.11-1.70 [P = .02]), 1.40 (0.70-2.81 [P = .34]), and 2.50 (1.53-4.08 [P < .001]) for patients with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. For patients with uveitis, IR ratios (95% CIs) were 1.59 (1.32-1.91 [P < .001]) for mild psoriasis, 2.17 (1.40-3.38 [P < .001]) for severe psoriasis, and 3.77 (2.66-5.34 [P < .001]) for psoriatic arthritis, respectively.
We found a bidirectional association between psoriatic disease and uveitis. Increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with prior or current uveitis may be appropriate.
重要性：银屑病、银屑病关节炎和葡萄膜炎都是具有显著重叠炎症途径的炎症性疾病。关于银屑病疾病和葡萄膜炎之间的关系，证据有限。
目的：研究银屑病疾病（包括银屑病和银屑病关节炎）和葡萄膜炎之间潜在的双向关系。
设计、地点和参与者：我们进行了一项全国性队列研究，纳入了 1997 年 1 月 1 日至 2011 年 12 月 31 日期间的 74129 名丹麦成年银屑病患者。通过行政登记册识别患者，并使用个体水平的行政登记册链接获取年龄、性别、社会经济状况、药物和合并症的信息。我们于 2015 年 1 月 27 日至 3 月 4 日进行数据分析。
暴露：葡萄膜炎风险时诊断为轻度或重度银屑病或银屑病关节炎，以及银屑病或银屑病关节炎风险时诊断为葡萄膜炎。
主要结果和测量：诊断为葡萄膜炎、轻度银屑病、重度银屑病或银屑病关节炎。我们使用泊松回归计算了潜在混杂因素调整后的发病率（IR）和估计的 IR 比值。
结果：我们确定了 74129 例银屑病和银屑病关节炎病例和 13114 例葡萄膜炎病例。葡萄膜炎的 IR（95%CI）分别为参考人群和轻度银屑病、重度银屑病和银屑病关节炎患者的 2.02（1.99-2.06）、2.88（2.33-3.56）、4.23（2.40-7.45）和 5.49（3.36-8.96）。在参考人群中，这些 IR（95%CI）分别为 9.37（9.30-9.45）、1.12（1.10-1.15）和 1.04（1.01-1.06），而在葡萄膜炎患者中，这些数据分别为轻度银屑病、重度银屑病和银屑病关节炎的 15.51（12.92-18.62）、2.66（1.72-4.13）和 4.25（3.00-6.01）。葡萄膜炎的调整后 IR 比值（95%CI）分别为轻度银屑病患者的 1.38（1.11-1.70 [P = .02]）、重度银屑病患者的 1.40（0.70-2.81 [P = .34]）和银屑病关节炎患者的 2.50（1.53-4.08 [P < .001]）。对于患有葡萄膜炎的患者，IR 比值（95%CI）分别为轻度银屑病患者的 1.59（1.32-1.91 [P < .001]）、重度银屑病患者的 2.17（1.40-3.38 [P < .001]）和银屑病关节炎患者的 3.77（2.66-5.34 [P < .001]）。
结论和相关性：我们发现银屑病疾病和葡萄膜炎之间存在双向关联。在患有银屑病和银屑病关节炎的患者中，更加关注眼部症状，在患有既往或现症葡萄膜炎的患者中，更加关注皮肤和关节症状，可能是恰当的。
