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Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis: a population-based cohort study
  1. Rachel Charlton1,
  2. Amelia Green1,2,
  3. Gavin Shaddick3,
  4. Julia Snowball1,
  5. Alison Nightingale1,
  6. William Tillett1,4,
  7. Catherine H Smith5,
  8. Neil McHugh1,4
  9. on behalf of the PROMPT study group
    1. 1Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
    2. 2Department of Mathematical Sciences, University of Bath, Bath, UK
    3. 3Department of Mathematics, University of Exeter, Exeter, Devon, UK
    4. 4Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
    5. 5Guy’s and St Thomas’ Foundation Trust, St John’s Institute of Dermatology, London, UK
    1. Correspondence to Dr Rachel Charlton, Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath BA27AY, UK; r.a.charlton{at}bath.ac.uk

    Abstract

    Objectives To determine the risk of uveitis and inflammatory bowel disease (IBD) in patients with psoriatic arthritis (PsA) compared with the general population and patients with psoriasis.

    Methods A cohort study using data from the UK Clinical Practice Research Datalink between 1998 and 2014. Patients with incident PsA aged 18–89 years were identified and matched to a cohort of patients with psoriasis and a general population cohort. The incidence of uveitis, all IBD, Crohn’s disease and ulcerative colitis was calculated for each study cohort and adjusted relative risks (RRadj) were calculated using conditional Poisson regression.

    Results 6783 incident cases of PsA were identified with a median age of 49 years. The risk of uveitis was significantly higher in the PsA cohort than in the general population and psoriasis cohorts (RRadj 3.55, 95% CI 2.21 to 5.70 and RRadj 2.13, 95% CI 1.40 to 3.24, respectively). A significant increase was observed for Crohn’s disease (RRadj 2.96, 95% CI 1.46 to 6.00 and RRadj3.60, 95% CI 1.83 to 7.10) but not for ulcerative colitis (RRadj1.30, 95% CI 0.66 to 2.56 and RRadj0.98, 95% CI 0.50 to 1.92).

    Conclusions In a primary care-based incidence cohort of patients with PsA, there were substantial risks of developing uveitis and/or Crohn’s disease, but not ulcerative colitis, when compared with the general population and psoriasis controls.

    • psoriatic arthritis
    • epidemiology
    • arthritis

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    Footnotes

    • The initial findings of the study presented in this manuscript were presented as a poster presentation at the British Society for Rheumatology Conference 2017. Rheumatology, volume 56, Issue Suppl_2, 1 April 2017, kex062.048, https://doi.org/10.1093/rheumatology/kex062.048.

    • Handling editor Josef S Smolen

    • Contributors WT, NM, AN, GS and CHS contributed to the conception of the study. All authors contributed to the design of the work. Data acquisition and analysis was carried out by RC, JS, AN, AG and GS. All authors were involved in the interpretation of the study results as well as the drafting and revision of the manuscript and all approved the final version to be published.

    • Funding This report is an independent research funded by the National Institute for Health Research (Programme Grants for Applied Research, Early detection to improve outcome in patients with undiagnosed psoriatic arthritis, RP-PG-1212-20007). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

    • Competing interests All authors report grants from the National Institute for Health Research (RP-PG-1212-20007) during the conduct of the study. CHS reports grants from the Medical Research Council (MR/L011808/1) outside the submitted work. AN and GS report grants from Pfizer and Celgene outside the submitted work.

    • Ethics approval Ethical approval has been obtained by the CPRD data provider from a Multi-centre Research Ethics Committee (MREC) for all observational studies and the study protocol was approved by the CPRD Independent Scientific Advisory Committee (15_154R).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators PROMPT study group includes: Sarah Hewlett, Helen Harris, Philip Helliwell, Laura Coates, Catherine Fernandez, Sarah Brown, Claire Davies, Jonathan Packham, Laura Bjoke, Eldon Spakman, Anne Barton, Oliver Fitzgerald, Vishnu Madhok, Melanie Brooke, Jana James and Andrew Parkinson.

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