• People living with psoriatic arthritis (PsA) are at a higher risk of developing uveitis, an inflammatory disorder that affects the uvea (middle layer of the eye).
• Symptoms of uveitis include eye pain, redness, and changes in vision.
• If uveitis isn’t treated quickly, it can lead to vision loss and other complications.

Although psoriatic arthritis is typically thought of as a disease affecting the joints, one lesser-known PsA symptom is uveitis, which causes eye inflammation and vision symptoms.

“I’ve been struggling with uveitis from my psoriatic arthritis and nothing is helping,” one MyPsoriasisTeam member wrote. Another said, “I also have uveitis — I’ve been treated for about a year and a half and it’s improving.”

People with severe psoriatic arthritis have an increased risk of uveitis (also known as ocular inflammation) compared to the general population. The prevalence of uveitis also tends to be higher in individuals with both psoriasis and PsA or PsA alone than in those with just psoriasis.

Although recurrent uveitis is a relatively rare complication of psoriatic disease, it’s considered very serious. Talk to your doctor or rheumatologist if you suspect your PsA is affecting your eyes and vision.

What Is Uveitis?

Uveitis is an inflammatory disorder that affects the middle layer of the eye, known as the uvea or uveal tract. The uvea contains several structures:

• The iris, or colored part of the eye, which dilates and contracts to regulate how much light enters the eye
• The choroid, which contains blood vessels and lines the back of the eye
• The ciliary body, which contains muscle and connects the iris to the choroid

Uveitis can affect different structures in the uvea, causing vision changes and eye pain, among other symptoms. There are several different types of uveitis, identified by where the inflammation occurs and how long it lasts.

Depending on the duration of uveitis, it can be classified as acute uveitis, which develops quickly and improves within three months, or as chronic uveitis, which is long-lasting and can return months after stopping treatment.

Anterior Uveitis

Anterior uveitis is the most common form of uveitis. It accounts for approximately 3 in 4 cases of uveitis. There are two types of anterior uveitis: iritis, which affects the front section (chamber) of the eye and the iris, and iridocyclitis, which also involves the ciliary body.

Anterior uveitis affects the anterior uveal tract (the portion of the uvea found in the front of the eye). Anterior uveitis tends to come on quickly and can cause eye redness and pain, which may be severe. As one MyPsoriasisTeam member shared, “I’ve been in the hospital today with the worst eye pain I’ve ever experienced. It seems I have acute anterior uveitis — an inflammation linked to psoriasis, which I had never heard of.”

Intermediate Uveitis

Intermediate uveitis occurs in the middle portion of the eye just behind the iris and lens. Intermediate uveitis can lead to blurred vision and floaters, or spots and flecks in the field of vision.

Posterior Uveitis

Posterior uveitis — also known as choroiditis — causes inflammation in the choroid (back portion of the uvea). This rare form of uveitis may affect the retina and optic nerve, potentially leading to permanent vision loss.

Panuveitis

In some cases, inflammation can occur in both the front and back of the eye. This condition is referred to as panuveitis.

What Are the Symptoms of Uveitis?

Uveitis can affect one or both eyes. The symptoms caused by inflammation can develop suddenly or build gradually over several days. These symptoms include:

• Eye pain — Usually, a dull ache in or around the eye that may worsen when focusing
• Eye redness
• Changes in vision, such as blurring or cloudiness
• Photophobia (light sensitivity)
• Eye floaters (small shapes, spots, or flecks that drift across the field of vision)
• Loss of peripheral vision (the ability to see objects on the sides of the field of vision)

Uveitis is often mistaken for viral conjunctivitis (“pink eye”). Pink eye is characterized by swollen eyelids and mucous discharge. However, it is unlikely to cause the eye pain, light sensitivity, and vision loss (in severe cases) more commonly seen in uveitis. It may not always be easy for someone with uveitis to tell it apart from everyday eye irritation. For this reason, it’s important to see a doctor or ophthalmologist (eye specialist) if you experience any eye symptoms, especially if they’re not going away or are getting worse.

What Does Uveitis in Psoriatic Arthritis Feel Like?

Members of MyPsoriasisTeam have shared their experiences with eye inflammation, including what it felt like and when they knew something was wrong.

As one member shared, “I woke up in the middle of the night with screaming eye pain. I could only get in to my primary care provider, who suspected iritis/uveitis and said to get in to my eye doctor as soon as I could.”

Fortunately, this member shared that their pain started improving within 12 hours: "By hour 20, it was 90 percent better.”

What Causes Uveitis in Psoriatic Arthritis?

In people with autoimmune diseases, including psoriatic diseases like PsA, the immune system — which protects your body from invaders — mistakenly attacks the body’s own healthy tissues. The overactive immune system can target multiple areas of the body, including the eyes. When the immune system mounts an attack against foreign invaders, it reacts by releasing inflammatory cells. These cells can enter the many blood vessels in the uvea, causing damage and inflammation.

Certain antibodies (proteins that play a role in the immune response) are thought to be involved in the development of uveitis. Two of these antibodies are tumor necrosis factor (TNF)-alpha and HLA-B27. According to one study, HLA-B27 has been found to play a role in 30 percent to 40 percent of uveitis cases in people with PsA.

How Is Uveitis in PsA Treated?

It’s important to treat uveitis as soon as symptoms begin to occur. As one MyPsoriasisTeam member noted, “You need to see an ophthalmologist because these conditions can be very dangerous, but can be cleared up quickly with combination steroid and antibiotic drops. The symptoms can come and go, but if left untreated, you could lose your sight.”

Uveitis must be treated as soon as possible, and recurrent episodes must be prevented so as to avoid vision loss and other complications. Your doctor or ophthalmology expert can help you understand the cause of your eye symptoms and determine the best ways to manage them.

Nonsteroidal Anti-Inflammatory Drugs

Psoriasis-related uveitis is more likely to require treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) than other forms of uveitis. Oral NSAIDs have been found to reduce the relapse rate of recurrent anterior uveitis.

Steroid Medications

Most cases of uveitis can be treated with steroids — medications that prevent the immune system from releasing inflammation-causing chemicals. Steroid medications are available in different forms, including eye drops, ocular injections, and ocular implants. The type of medication your doctor prescribes depends on which parts of your eye are inflamed.

One MyPsoriasisTeam member experiencing uveitis was advised to combine pain-relieving medications and steroid eye drops: “I’m on hourly steroid drops and painkillers.”

Biologics

Biologic therapy helps control eye inflammation and prevent relapses by targeting specific parts of the immune system that cause inflammation. You may already be taking a biologic to treat your psoriatic arthritis, but if you have recurrent uveitis, you should talk to your doctor about switching to a more efficient biologic therapy.

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Have you developed uveitis alongside psoriatic arthritis? How was your eye inflammation treated? Share your experience in the comments below, or start a conversation by posting on your Activities page.