Visual Functions in Psoriatic Arthritis Sine-Psoriasis May Be Linked to Systemic Inflammation

eye examination, optometrist
Researchers analyzed dry eye and subclinical retinal abnormalities in a cohort of patients with psoriatic arthritis sine-psoriasis.

Dry eye and subclinical abnormalities in visual functions in patients with psoriatic arthritis (PsA) sine-psoriasis may be related to systemic inflammation, according to study results published in the Journal of Clinical Medicine.

In this noninterventional, cross-sectional study, the disease activity of patients aged 18 to 65 years with diagnosed PsA and no evidence of skin psoriasis (n=40) was assessed by an experienced rheumatologist; a healthy control group (n=35) was also included in the study. All patients received a standard ophthalmology exam, which included best-corrected visual acuity, ocular surface disease index questionnaire, Schirmer test, and tear film breakup time (BUT). Standard automated perimetry, spectral-domain optical coherence tomography, and fundus perimetry scans were performed in all patients.

Researchers evaluated 80 and 70 eyes from patients in the PsA group (72.5% women; mean age, 52±14 years) and the healthy control group (60% women; 48.7±13.8 years) , respectively. The best-corrected visual acuity of patients in the PsA group and the healthy control group were similar, and an abnormal ocular surface disease index (OSDI) was observed in 60% of patients with PsA. Prevalence of dry eye was significantly greater in the PsA group compared with the healthy control group (P <.0001). Approximately 75% of patients in the PsA group (n=30) were definitively diagnosed with dry eye (39.9% with BUT <10 sec; 23.4% with Schirmer ≤5 mm; 36.7% with both BUT <10 sec and Schirmer ≤5 mm).

Researchers indicated a positive correlation between OSDI and erythrocyte sedimentation rate (ESR; r=0.6; P <.001), In terms of the Schirmer test values, a negative correlation was observed between the scale of wetness and ESR (r=-0.43; P =.007). Results from standard automated perimetry indicated a higher mean deviation and pattern standard deviation in the PsA group compared with the healthy control group (P <.0001 and P =.005, respectively). In addition, ESR and C-reactive protein (CRP) showed a positive association with pattern standard deviation (r=0.3 and r=0.4; P =.04 and P =.01, respectively), while CRP was also correlated with mean deviation (r=-0.4; P =.01). Patients with PsA and the control participants demonstrated a similar visual field index (range, 98%-100%). 

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“Assuming that relevant signs of systemic disease may be revealed as abnormalities occurring in the eye, a clinical evaluation of retinal morphology and function should be performed in order to detect subclinical damage of the visual system early,” the researchers advised. “In addition, careful ophthalmologic examination of patients with PsA sine-[psoriasis] may produce valuable clinical information on disease activity status. Using either [standard automated perimetry] or [fundus perimetry] and [optical coherence tomography] assessment could allow the detection of early changes in visual function even before clinically detectable retinopathy. These ancillary tests may serve as a useful monitoring tool over the entire course of the disease.”


Chimenti MS, Triggianese P, Salandri G, et al. A multimodal eye assessment in psoriatic arthritis patients sine-psoriasis: evidence for a potential association with systemic inflammation. J Clin Med. 2020;9(3):E719.