When you hear the word “psoriasis,” you likely think itchy, scaly red elbows. “Arthritis” conjures up painful, swollen joints. But you can have both at the same time; it’s called psoriatic arthritis, or PsA.
Like psoriasis, PsA is an autoimmune disorder where your overactive immune system attacks healthy parts of your body, causing inflammation. It can flare up anywhere, including the eyes.
According to the National Psoriasis Foundation, one of the most common eye disorders associated with PsA is uveitis (you-vee-EYE-tis). Uveitis is characterized by inflammation (redness and swelling) that occurs in the uvea, the layer and structures beneath the white of the eye. About 7 percent of those with PsA will develop the disease, a much higher percentage than found in the general population, according to the National Eye Institute.
If you have PsA and something feels off with your eyes or vision see an ophthalmologist for an exam. “Don’t assume it’s pink eye,” says Kristin Ingraham, DO, a rheumatologist with Lehigh Valley Health Network in Allentown, PA. “Delaying a diagnosis can make flare-ups worse.”
To check for the condition, an ophthalmologist will perform a non-invasive “slit lamp” exam using a special microscope and high-intensity light to examine different structures and look for white blood cells and protein within the eye. “There should be no white blood cells inside the anterior chamber of the eye, and in uveitis you find them,” explains James Rosenbaum, M.D., professor of medicine in the Division of Arthritis and Rheumatic Diseases at Oregon Health & Science University and chief of ophthalmology at Legacy Devers Eye Institute in Portland, OR. “A lot of protein in the eye suggests the blood vessels are leaky; the protein actually diffracts the lamp’s beam of light so it’s like looking through a fog.”
It’s also vital to keep an eye out for unusual symptoms between appointments. Dr. Rosenbaum recommends keeping in mind the mnemonic R.S.V.P. If you experience any of these four issues, see an ophthalmologist stat:
R – Prolonged redness
Eye redness is very common and can be triggered by allergies, a virus, or strain. (You know, from reading the tiny text on your smartphone.) But if the redness lasts for a week or more, check-in with your doctor.
S – Sensitivity to light
“Things that don’t damage the eye, like mild conjunctivitis, don’t generally cause a sensitivity to light,” says Dr. Rosenbaum. Light sensitivity may suggest a more serious problem brewing.
V – Vision change
Blurred vision, double vision, “floaters,” or any other changes in visual acuity should be checked by an ophthalmologist.
P – Pain
Many minor conditions cause some scratchiness and discomfort but not true pain, says Dr. Rosenbaum. “True pain definitely needs to be evaluated,” he says.
The importance of uveitis treatment
Waiting too long to have your eyes checked after symptoms start can delay treatment and allow damage to occur, so definitely don’t drag your feet, says Dr. Ingraham.
Treatment for moderate inflammation from uveitis often involves steroid eye drops. For some people with more severe symptoms, the medication used to treat psoriasis or psoriatic arthritis may be used to treat or prevent uveitis. Your eye doctor and rheumatologist can work together to find your best course of treatment. “Just as a conductor of a symphony coordinates multiple musicians, rheumatologists and ophthalmologists should achieve a similar collaboration,” says Dr. Rosenbaum.
What about lifestyle factors; can they prevent eye problems related to psoriatic arthritis? “Boy, I wish,” says Dr. Rosenbaum. “If you have a way to reduce stress, to be happy, to get sleep, to eat a balanced diet, do all of those things, but don’t ignore conventional medications, which we know work well.”
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