Uveitis is the inflammation of the uvea, or the middle layer of the eye that’s located under the white of the eye. This layer is made up of the iris, the ciliary body (the tissue around the lens), and the choroid (which includes connective tissue and blood vessels in the eye). People with psoriatic arthritis are at a higher risk of developing this inflammation of the eye, says John M. Davis, III, MD, a rheumatologist at the Mayo Clinic in Rochester, Minnesota. The reasons for this increased risk are uncertain, according to Dr. Davis. But it’s likely the inflammation that causes joints to flare can also affect some of the tissues in the eye, he says. People with the gene for the human leukocyte antigen HLA-B27 may have a higher risk of certain autoimmune conditions, including psoriatic arthritis and uveitis, according to the U.S. National Library of Medicine. “The presence of HLA-B27 gene causes a gene product that promotes inflammation,” says Mandi D. Conway, MD, professor and interim chair of ophthalmology at the University of Arizona College of Medicine-Phoenix. The symptoms can come on suddenly or gradually, adds James T. Rosenbaum, MD, founder of the Uveitis Clinic and the director of inflammatory research at Oregon Health & Science University in Portland. Any of these symptoms that persist for a few days should be evaluated by an ophthalmologist, he says. “You may see a rheumatologist for your psoriatic arthritis,” he says, “but a rheumatologist doesn’t have the tool kit to examine your eyes thoroughly.” Conway agrees. “If you start experiencing symptoms, it’s important that you see an ophthalmologist right away,” she stresses. The disease can cause irreversible damage to the delicate tissues in your eye, and you want to intervene before that happens, Dr. Rosenbaum adds.
How Uveitis Is Treated
Your doctor may give you steroid drops to reduce inflammation. Or, if your case is severe, you may need oral steroids or steroid shots around the eye — “the way we would inject a painful shoulder,” Rosenbaum says. If an infection is the cause of the inflammation, you may be given an antibiotic as well, the Arthritis Foundation says. Most of the time, drops work well if the uveitis affects the iris and the ciliary body. But if it affects the back of the eye, the drops have less ability to penetrate, and treatment becomes more complicated, Rosenbaum says. In some people, says Rosenbaum, uveitis is short-lived and responds well to drops. But because it’s an episodic disease, people may go through a dormant period only to have it flare again. “In other patients, it’s more chronic, and in a few [people], it will last years and years,” he says. “It’s somewhat like arthritis in that it’s unpredictable how it will twist and turn.” The hope is that, after taking steroid drops and tapering off them, your uveitis will go away, Conway says. Steroids aren’t a long-term solution because they can cause glaucoma, a rise in fluid pressure in your eye, and a steroid-induced cataract. Nonsteroidal drops are an alternative in some cases, Conway says. “If uveitis comes back, your doctor may put you on a systemic drug such as a methotrexate or a biologic to modulate your immune system,” she adds. Methotrexate and biologics are drugs that also can treat your psoriatic arthritis symptoms. Current biologic treatments for uveitis may include adalimumab, which is FDA approved for non-infectious uveitis, says Davis. “We have some experience that other biologics may also be helpful, such as IL-6 antagonists, but more research is necessary to define the use of those agents,” he says. It’s impossible to predict who will get uveitis or when. “We can’t anticipate when your immune system will decide to flare up,” Conway says. People who have HLA-B27 and more than three episodes of uveitis that last more than six weeks each should consider systemic therapy, she says. “If that’s the case, I may put them on a systemic medicine to prevent recurrent inflammation in the eye. That’s 18 weeks a year that they’re uncomfortable or putting topical pharmaceuticals in the eye,” she adds. Additional reporting by Susan Jara
