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C Foster, K Durrani; Psoriatic Uveitis: An Established Clinical Entity . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4254.
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Purpose: The aim of this study is to provide a clinical description of uveitis occurring in psoriatic patients, and to allow further epidemiologic testing of the strength of association between the two conditions. Method: The records of forty two consecutive patients with a dual diagnosis of psoriasis and uveitis attending the Uveitis Service at the Massachusetts Eye & Ear Infirmary were reviewed. Clinical characteristics were determined and chi square and Fisher exact tests were used to determine associations between HLA-B27 positivity and severity of inflammation and treatment required. Results: Initial review revealed 42 patients with a diagnosis psoriasis and uveitis. Sarcoidosis was diagnosed in two, and CNS-intraocular lymphoma in one of these patients. Of the remaining 39 patients, uveitis tended to be anterior (71.8% of patients), recurrent (84.7%), and in many cases, bilateral (48.7%), with a mean maximum grade of cells being 1.4 (SD 1.3). Associated retinal findings included cystoid macula edema (20.5%), retinal vasculitis (10.3%), and discrete atrophic retinal lesions (7.7%). HLA-B27 positivity was not associated with severity of inflammation (p=0.37). However, HLA-B27 positive patients were more likely to require oral non-steroidal anti-inflammatory drugs (RR 2.94, p=0.012) or systemic immunomodulation, using Methotrexate (RR 3.47, p=0.022) for control and prophylaxis of ocular inflammation. Conclusion: Psoriatic uveitis may be a separate clinical entity and can have associated retinal findings. Patients with psoriasis who are HLA-B27 positive are more likely to require oral NSAID or systemic immunomodulation than HLA-B27 negative patients. Further epidemiologic tests are required to determine the strength of association between psoriasis and uveitis.
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