RESEARCH - Immune-mediated skin lesions in patients treated with TNF inhibitors

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Scand J Rheumatol. 2009;38(5):328-31.

Immune-mediated skin lesions in patients treated with anti-tumour

necrosis factor alpha inhibitors.

Exarchou SA, Voulgari PV, Markatseli TE, Zioga A, Drosos AA.

Rheumatology Clinic, Department of Internal Medicine, Medical School,

University of Ioannina, Ioannina, Greece.

Abstract

OBJECTIVE: To describe immune-mediated skin lesion (IMSL) development

in patients during anti-tumour necrosis factor (TNF) therapy.

METHODS: Two hundred and fifty-two patients with rheumatoid arthritis

(RA) and 183 with spondyloarthropathies (SpA) treated with anti-TNF

inhibitors were analysed to identify IMSLs.

RESULTS: Of the 252 patients with RA (146 treated with infliximab, 72

with adalimumab, and 34 with etanercept), 32 developed IMSLs. Eleven

patients developed psoriatic skin lesions, 10 presented with granuloma

annulare (GA), five had skin vasculitis, two alopecia areata, two

discoid lupus erythematosus, one lichenoid eruption (lichen planus),

and one vitiligo. Of the 183 patients with SpA (138 treated with

infliximab, 37 with etanercept, and eight with adalimumab), 10 cases

with IMSLs were identified. All were treated with infliximab. More

specifically, six patients with ankylosing spondylitis (AS) developed

psoriatic skin lesions, one developed GA, one lichen planus, and one

alopecia areata. In addition, one patient with psoriatic arthritis

(PsA) developed skin vasculitis. The occurrence of these IMSLs ranged

from 3 to 36 months with a median of 20 months. Of all the patients

with IMSL development, two with psoriatic skin lesions, two with GA,

and one with vasculitis stopped anti-TNF therapy because of the extent

and severity of the skin lesions.

CONCLUSIONS: Our results on patients treated with TNF antagonists

strongly support a link between TNF inhibition and IMSL development.

Although these clinical complications are rare, clinicians should be

aware of their occurrence and should recognize them.

PMID: 19579151

http://www.ncbi.nlm.nih.gov/pubmed/19579151

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