CASE REPORTS - TNF inhibitor-induced psoriasis: a cytokine imbalance between TNF-alpha and IFN-alpha?

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J Clin Rheumatol. 2008 Dec;14(6):353-6.

Biologic therapy (TNF-alpha antagonists)-induced psoriasis: a cytokine

imbalance between TNF-alpha and IFN-alpha?

Cuchacovich R, Espinoza CG, Virk Z, Espinoza LR.

Section of Rheumatology, Departments of Internal Medicine and

Pathology, LSU Health Sciences Center at New Orleans, New Orleans, LA

70115, USA.

We report 3 patients with psoriatic arthritis and 2 with rheumatoid

arthritis who developed worsening, and/or de novo psoriasis, and/or

psoriasiform rash, while on tumor necrosis factor antagonist therapy.

All 5 patients initially presented with active skin, and/or joint

inflammatory involvement, and exhibited significant clinical response

to tumor necrosis factor antagonist therapy. Within approximately 6

months, however, psoriatic and/or psoriasiform rash developed de novo

in 2 rheumatoid arthritis patient and exacerbated in the other 3

patients. Biopsy findings revealed histologic and immunohistochemical

changes indistinguishable from psoriasis.Psoriatic rash improved after

discontinuation of biologic therapy and/or initiation of a short

course of oral prednisone. One patient with psoriatic arthritis was

rechallenged with infliximab due to exacerbation of both psoriasis and

psoriatic arthritis, and this was followed by prompt improvement of

both conditions. At 6 months follow-up, this patient remains under

excellent control. To date, there have been over 50 cases of this type

of dermatologic complication described. Interferon alpha seems to play

an important role in the pathogenesis of this complication. This type

of complication has been described with all 3 available tumor necrosis

factor inhibitors, and most patients improve after discontinuation of

biologic therapy.

PMID: 19033869

http://www.ncbi.nlm.nih.gov/pubmed/19033869

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