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Psoriatic arthritis in eyes: Psoriatic Arthritis and Eye Problems

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Psoriatic Arthritis and Eye Problems

Does psoriatic arthritis affect your eyes? The answer may surprise you.

Research shows the same inflammation that causes joint problems in people with psoriatic arthritis can also damage other areas of the body, including the eyes, according to the Arthritis Foundation.

Eye dryness, eye pain, and conjunctivitis are some common problems associated with psoriatic arthritis. A less-frequent psoriatic eye condition is inflammation in the middle layer of the eye, known as uveitis, which can lead to permanent eye damage and vision loss if left untreated.

But psoriatic arthritis eye problems can be effectively remedied if diagnosed early. “Patients have to have an understanding of what the symptoms can be,” says Mark Fisher, MD, MPH, a rheumatologist in Fall River, Massachusetts. “Vigilance is really important.”

Below are some psoriatic arthritis signs and symptoms that might warrant a visit to your doctor.

Psoriasis Flare-Ups Around the Eye

When a psoriasis flare-up occurs around the eyes, the eyelids and eyelashes become red and crusty and covered in scales, causing the rims of the lids to turn up or down. If the rims turn down, the lashes may rub against the eyeball and cause further irritation, notes the Psoriasis and Psoriatic Arthritis Alliance.

If you notice any psoriasis flare-ups around your eyes, consult with a dermatologist and an ophthalmologist. Treatment typically involves applying topical medication to remove the scales on the eyelids. Be sure to follow your provider’s instructions on how to apply topical treatments around the eye. Overuse of certain topicals in the eye area may increase the risk of cataracts and glaucoma, cautions the National Psoriasis Foundation.

“By starting early treatment we can prevent any damage from happening,” says Dr. Fisher. “Medications really do work.”

RELATED: 9 Tips to Avoid Infections When Taking Biologics for Psoriatic Arthritis

Conjunctivitis

Commonly known as pink eye, conjunctivitis is the swelling or inflammation of the conjunctiva, the thin, transparent layer of tissue that lines the inner eyelid and covers the white part of the eye. Red, itchy eyes due to conjunctivitis occur more commonly among people with psoriasis, according to the Mayo Clinic. Indeed, some research published in February 2017 in Open Access Text suggests that more than 60 percent of psoriasis patients experience conjunctivitis at some point.

Symptoms of conjunctivitis include redness in the whites of the eyes, itchy eyes, and increased tearing. If you experience any signs of pink eye, get in touch with your doctor. Treatment typically involves eye drops or ointments, but may also include oral medications to treat the underlying psoriatic arthritis.

RELATED: What Psoriatic Arthritis Really Feels Like

Uveitis

Uveitis is inflammation that starts in the uvea, a part of the eye between the retina (the inner layer of the eye) and sclera (the outer white layer of the eye). If left untreated, uveitis can eventually lead to vision loss.

About 7 percent of psoriatic arthritis patients develop uveitis, according to the Arthritis Foundation. “For patients who test positive for the HLA-B27 gene, that number may be a little higher,” notes Fisher. The HLA-B27 gene encodes an antigen that helps the immune system function. Some patients who have this gene are more likely to get inflammation in the eye.

Symptoms of uveitis include eye pain, red eyes, blurry vision, floaters (seeing specks or shadows), and sensitivity to light, according to the National Eye Institute.

Doctors typically begin uveitis treatment with corticosteroid eye drops, and they may also turn to other immunosuppressive medications, such as traditional disease-modifying drugs and biologic agents, says the Arthritis Foundation. With the right medication, uveitis will go away, but relapses may occur.

“Once a patient is known to have uveitis, doctors usually recommend they keep a bottle of steroid eye drops so they can start treatment before they get in to see the eye doctor,” Fisher says.

RELATED: Is It Psoriatic Arthritis or Fibromyalgia?

Changes in Eyelids

Rarely, people with psoriatic arthritis eye problems can develop ectropion, a serious eye condition in which the eyelids and lashes turn outward away from the eyeball. The condition, which is more prevalent in older adults, most commonly affects the lower eyelid and can be moderate (where only one part of the eyelid turns away from the eye) or severe (where the entire eyelid is turned out), says the Mayo Clinic.

Symptoms of ectropion include excessive tearing or eye dryness, irritation, burning, redness or chronic conjunctivitis, and visible drooping of the lower eyelid.

If you experience any signs of ectropion, seek medical help right away. “This is too serious if missed or delayed,” stresses Ana-Maria Orbai, MD, the director of the psoriatic arthritis program at the Johns Hopkins Arthritis Center in Baltimore.

Although artificial tears and lubricating ointments can offer temporary relief, treatment of ectropion typically requires surgery.

Additional research by Julia Califano.

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How Does Psoriatic Arthritis Affect Eyes?

Written by Alexandra McCray

  • How Psoriatic Arthritis Affects Your Eyes
  • Other Conditions

If you have psoriatic arthritis, you might get thick, red patches of skin with scales on them. Your joints may swell and ache, too.

Symptoms might also show up in places you don’t expect, like your eyes. Here’s what you need to know.

Both psoriasis and psoriatic arthritis are autoimmune diseases. That means they cause your body to attack itself by mistake. This can trigger inflammation in certain parts of the body, including your eyes.

If your eyes are irritated and you have psoriasis, you may have uveitis. That’s a term for any inflammation inside your eye. It can lead to swelling and damaged eye tissue. Uveitis may affect one or both eyes. Symptoms include:

  • Blurry vision
  • Dark, floating spots in your line of vision called floaters
  • Eye pain and redness
  • Light sensitivity

Treatment for psoriatic arthritis may help your uveitis. Your doctor might also give you steroid drugs that curb your immune system. These may ease eye inflammation.

Ongoing inflammation can lead to other eye issues. These include:

Conjunctivitis (pinkeye). This is inflammation or infection of the layer that covers the white part of your eyes. Symptoms include:

  • Red and itchy eyes
  • Feeling like there’s something in your eye
  • Crusty discharge
  • Tearing up

Your eye doctor can treat pinkeye.

Glaucoma. This is a group of conditions that damage your optic nerve. It often starts with inflammation that causes a buildup of pressure in your eye. Symptoms include:

  • Blurry vision
  • Halos or empty spots in your line of vision
  • Eye pain and redness

You may not have any of these if the disease is in its early stages. That’s why regular eye exams are important. Your eye doctor can catch it even if yo’re not showing symptoms. Glaucoma can also be a side effect of taking corticosteroids for psoriatic arthritis. Talk to you doctor about how to lower this risk.

Cataracts. That ’s when inflammation turns the clear lens of your eye cloudy. Symptoms can include:

  • Trouble seeing at night
  • Blurry vision
  • Double vision in one eye
  • Changes to your glasses or contacts prescription

Steroids you put on your skin or take by mouth for long periods of time can raise your risk for this disease at am earlier age. Cataracts are usually treated with surgery. Your eye doctor will take out the cloudy lens and put in an artificial one.

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How rheumatoid arthritis can affect the eyes

Although rheumatoid arthritis primarily affects the joints, it can also affect many other organs, including the eyes. Various eye pathologies are among the most common comorbidities in people with RA. Studies say that 30 to 40% of people diagnosed with RA experience eye problems such as dryness, redness, and pain [2].

What causes eye problems in RA?

The immune-inflammatory process in rheumatoid arthritis mainly affects the connective tissue and can spread not only to the tissues of the joint, but also to other organs. Apparently, the inflammatory response caused by rheumatoid arthritis can also affect the tissues of the eye and lead to their damage [2].

Also, pathological changes in the eyes can develop due to side effects from drugs that are used to treat RA.

Depending on the structures and tissues of the eye that RA attacks, different types of eye diseases can occur. Let’s talk about the six most common of them.

Keratoconjunctivitis sicca (or dry eye syndrome)

This is a common eye condition that causes dryness of the conjunctiva and cornea. The conjunctiva is a thin transparent mucous membrane that covers the entire back surface of the eyelids and the eyeball in front. And the cornea is the anterior most convex transparent part of the shell of the eyeball. The conjunctiva is involved in the secretion of mucus and tear fluid to moisten the eye, and also protects the eye from the entry of foreign particles. The cornea performs a predominantly protective function and is the main refractive medium of the eye, that is, it is responsible for visual acuity.

Dry eye syndrome occurs due to reduced tear production or increased evaporation. Such problems can appear for several reasons. For example, due to taking certain medications or damage to the tear-producing glands.

In RA, keratoconjunctivitis sicca is often a manifestation of Sjögren’s syndrome. This is an autoimmune disease that affects the external secretion glands (mainly lacrimal and salivary) and is manifested by inflammation and dry mouth. Reduced production of the lacrimal glands leads to dry eyes.

Dry eye syndrome is the most common eye disease in RA. Women suffer from it nine times more often than men. The risk of dry keratoconjunctivitis increases with age.

Symptoms of the disease :

  • sensation of dry eyes,
  • blurred vision,
  • burning sensation,
  • foreign body sensation in the eyes.

These conditions can lead to infection and scarring of the cornea.

How to treat . If the symptoms are due to Sjögren’s syndrome, medical treatment of the underlying disease, RA, may improve. And you can alleviate the symptoms with the help of replacement therapy in the form of artificial tears, ointments.

If your dry eye is caused by medication, you should discuss with your doctor if you can change the medication or reduce the dose. Artificial tear preparations will also help compensate for dryness.

People with dry eye syndrome are advised to use indoor humidifiers [3].

Scleritis

This is an acute autoimmune inflammation of the sclera of the eye. The sclera is a dense, opaque shell of the eyeball that is white or slightly bluish in color. It is made up of collagen fibers. The sclera makes up about 5/6 of the outer shell of the eye, the rest is occupied by the cornea. The sclera protects the eye from physical influences and excessive amounts of light rays.

If not properly treated, scleritis can lead to severe impairment of vision up to complete loss.

Symptoms of the disease :

  • redness that does not improve with OTC eye drops;
  • severe boring pain;
  • pain when touching the eye through the eyelid;
  • sensitivity to light;
  • lacrimation;
  • decreased vision.

How to treat . In some cases, corticosteroid eye drops can help control inflammation. But often the problem is too deep inside the eye to be treated locally. Scleritis is more of a symptom than an independent disease. Therefore, it is important to control RA itself with anti-inflammatory drugs. In the most severe cases of necrotizing scleritis, donor sclera or cornea grafting may be needed to cover the area of ​​thinned sclera [3].

Uveitis

This is a group of inflammatory diseases of the uveal tract – the vascular membrane of the eye, which is located between the retina and sclera. Uveitis is one of the top ten diseases leading to vision loss.

Symptoms of the disease :

  • pain when touching the eyes through the eyelid,
  • redness,
  • blurred vision,
  • appearance of small “flies” and dots before the eyes,
  • sensitivity to light,
  • lacrimation.

How to treat . First of all, you need to control the underlying disease – rheumatoid arthritis, in order to minimize the risk. If you experience symptoms of uveitis, contact your doctor immediately. The doctor will conduct an examination to clarify the cause of uveitis, since this symptom can be both a manifestation of RA and have an infectious cause. If the diagnosis is confirmed, your first prescription will be corticosteroid eye drops. If these do not help, the doctor may prescribe an oral corticosteroid or inject the drug directly into the eyes. If the cause of uveitis is infection, a course of antibiotics may be needed [3].

Retinal vascular occlusion

This is an eye disease in which there is a blockage of the veins or arteries that feed the retina. The mechanism is about the same as during a heart attack or stroke. Occlusion of the retinal vessels is usually caused by a blood clot entering the vessel.

Symptoms of the disease :

  • loss of vision,
  • veil over the eyes.

If an artery is blocked, loss of vision may be sudden and recurring. If a vein is blocked, vision loss may occur gradually.

How to treat. If an artery has been blocked, the damage may be permanent – there is currently no known treatment to restore vision. If the vein is blocked, laser surgery can help restore vision [3].

Glaucoma

Glaucoma is based on progressive damage to the optic nerve, or neuroopticopathy. The main cause of the disease is a periodic or constant increase in intraocular pressure (IOP). Glaucoma is one of the leading causes of irreversible vision loss in the world.

Glaucoma may be a side effect of corticosteroid therapy for RA.

Symptoms of the disease :

  • pain in the eyes,
  • intermittent blurred vision,
  • iridescent halos around light sources,
  • blurred vision in the dark,
  • “flies” before the eyes,
  • eye fatigue.

However, in the early stages, glaucoma has no symptoms.

How to treat . Regular eye exams can detect a problem early and improve the prognosis of the disease. Treatment for glaucoma involves the use of eye drops to lower intraocular pressure. If the drops do not help, surgery may be needed to increase fluid flow from the eye and reduce pressure.

The best way to prevent glaucoma associated with corticosteroid therapy in RA is to consult with your physicians, rheumatologist and ophthalmologist regularly. To reduce risks, the rheumatologist may minimize the use of corticosteroids, leaving the lowest doses for the shortest time for optimal results [3].

Cataract

This is one of the most common eye diseases. With a cataract, the lens of the eye, which is responsible for the refraction of light rays, becomes cloudy. The disease causes various degrees of visual impairment up to its complete loss.

Oral or topical steroids increase the risk of cataracts.

Symptoms of the disease :

  • reduced visual acuity,
  • cloudy or blurry vision,
  • blurred vision in the dark,
  • faded colors.

In cataracts, the pupil, which is usually black, may become grayish, yellowish, and sometimes white.

How to treat . Treatment of cataracts with medications is currently considered ineffective. The disease is treated surgically, in which the clouded lens is removed and replaced with an artificial one [3].

More to know about eye disease and RA

Steroid medications, as mentioned above, can aggravate eye problems such as cataracts and glaucoma. If you do not have eye conditions, steroids may increase your risk of developing them. Therefore, it is important to tell your doctor about all your health conditions, as well as any medications you are taking. For example, a commonly used drug for the treatment of RA, hydroxychloroquine, is known to cause retinal damage in some people and requires regular monitoring of the patient by an ophthalmologist [1].

How can people with RA reduce their risk of eye disease?

Patients with RA are recommended to be examined by an ophthalmologist annually or when any eye symptoms occur, such as itching, dryness, burning, redness, pain, photosensitivity, watery eyes, blurred vision, blurred or interference in the field of vision. No matter how minor your symptoms may seem, it’s important to tell your rheumatologist and ophthalmologist right away about any eye-related changes. Ideally, your rheumatologist and ophthalmologist should work together to create an optimal plan for the prevention and treatment of eye diseases [2].

Summary:

30-40% of people diagnosed with RA experience eye problems. It can be a simple discomfort due to dry eyes, and a serious disease that can lead to complete loss of vision.

Eye problems may develop due to the nature of rheumatoid arthritis or due to side effects of drugs to control RA. The most common eye diseases in rheumatoid arthritis are dry eye syndrome, scleritis, uveitis, retinal vascular occlusion, glaucoma, and cataracts.

To reduce the risk of developing eye diseases in RA, you need to visit an ophthalmologist regularly. At the first sign of eye problems, you should immediately inform your rheumatologist about them – the doctor can adjust the treatment regimen by changing the drugs or their dosage in order to reduce the effect of drugs on the eyes.

In order to cure eye diseases, first of all it is necessary to control the underlying disease – rheumatoid arthritis. Also, depending on the specific disease, doctors may prescribe eye drops, ointments and gels, artificial tears, a tear duct plug procedure, and various types of surgery to a patient with RA.

Psoriatic arthritis: treatment

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Psoriatic arthritis – a chronic disease that occurs against the background of ps oryaza. Today, psoriasis affects 2-3% of the population. It is a non-infectious dermatitis that affects the human skin. Scientists believe that this disease has an autoimmune nature, but the exact cause remains a mystery. Among patients with psoriasis, arthritis is quite common. It causes inflammation and deformation of the spine, joints of the legs, arms. The prevalence of the disease is about 13-47% of patients with psoriasis.

Joint damage occurs regardless of the patient’s sex and the stage of the disease. In 15% of patients, arthritis appears before skin lesions. However, more often psoriatic arthritis is observed with clear signs of psoriasis. The person experiences acute pain, and the fingers acquire an unnatural hue. The joints become inflamed asymmetrically. In this case, it is much easier to confirm the diagnosis. And as soon as possible, start treatment with qualified specialists of our clinic!

Clinic of Functional Disorders will save you from psoriatic arthritis! Our experts will conduct a thorough diagnosis, and then prescribe you an effective treatment. With the help of the latest equipment in the hands of competent specialists, we will restore your health!

Symptoms of the disease worsen between the ages of 25 and 65. The main cause of deterioration is severe stress, fear or overexertion. Psoriasis is considered a disease that is subtly related to the patient’s psyche. Therefore, nervous tension greatly affects the course of the disease, as well as its consequences, which include psoriatic arthritis. Symptoms aggravated by stress require immediate attention! Only a specialist can improve the patient’s condition.

If you have been diagnosed with psoriatic arthritis, treatment should not be postponed. The disease is easier to stop and cure at an early stage.

The cause of the onset and development of psoriatic arthritis is still unknown. Symptoms of disease appear spontaneously. A direct relationship between the degree of manifestation of psoriasis and arthritis has not been identified. The disease has periods of exacerbation and calm. If proper care and treatment are absent, a number of complications appear. Possible damage to internal organs. Eyes, heart, urinary tract can be affected.

If you have been diagnosed with psoriatic arthritis, treatment for should not be delayed.