Paradoxical Side Effect Related With Anti-Tumor Necrosis Factor Alpha Treatment

Abstract

Introduction:Anti-tumor necrosis factor (anti-TNF) treatments are effective in controlling disease activity in many immune-mediated diseases such as psoriasis and ankylosing spondylitis (AS). Although side effects such as infection and skin reactions are predictable in anti-TNF treatment; susceptibility to psoriasis is considered as a paradoxical side effect.Case report:We report a case of forty-year-old male patient with 7 years of AS was taking anti-TNF therapy. He admitted our clinic with widespread guttate sized round, crusty rashes at feet, legs and elbows. In pathological examination of lesions; focal parakeratosis, mild acanthosis, capillary proliferation in the papillary dermis and focal extravasated erythrocytes were observed. He was diagnosed as anti-TNF induced guttate psoriasis. Although there is no definite treatment option, topical treatments, interrupting drug treatment or adding a disease-modifying agent for psoriasis are recommended. In this case report, we aimed to share our clinical approach to the paradoxical psoriasis manifestation which developed after two different anti-TNF treatments in a patient with AS.

Biologic therapy and paradoxical reactions

“…Proportion rates of 44.8% and 36.3% for plaque and palmoplantar pustular psoriasis, respectively, were reported in the review by Brown et al, contrasting with a proportion of 49% for plaque and of 52% for palmoplantar pustular in the review from Collamer et al An estimated incidence rate of anti-TNF-α triggered psoriasiform dermatoses of 1.04-3.00/1000 person-years has also been reported in the literature, with infliximab as the most frequent anti-TNF-α involved, followed by adalimumab, making psoriatic dermatoses the most frequent form of PR and exceeding psoriasis prevalence among the general population (around 2%) 6,7 . Iborra et al reported the prevalence of this side effect as between 1.5% and 5% in patients who were using anti-TNF-α due to IBD 4 .…”

“…Inflammatory bowel disease (ulcerative colitis and Crohn's disease) has also been described by several authors as a PR to biologic therapy, with a prevalence of around 43 times higher than in the general population 1,2,4 . In the available literature, it is mostly associated with etanercept in reports concerning juvenile idiopathic arthritis and other inflammatory rheumatic conditions like ankylosing spondylitis, presenting in the form of Crohn's disease.…”

“…This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/). changes, frequently associated with PR, may be helpful to differentiate these entities, although sometimes, they can take place as part of the natural development of the disease, hence the difficulty of the management of these events [2][3][4][5] .…”

“…A known example is the development of induced IBD when anti-interleukin (IL) 17 drugs are employed, given the role this interleukin professes in maintaining homeostasis of the digestive tract mucosa. Furthermore, eczematous reactions secondary to IL-17 blockade and Th2 pathway hyper-regulation have been reported as a known drug class effect (12.1% of patients in ixekizumab Phase III trial, for example) [2][3][4][5] .…”

N‐Butanol Extract of Gastrodia elata Suppresses Inflammatory Responses in Lipopolysaccharide‐Stimulated Macrophages and Complete Freund’s Adjuvant‐ (CFA‐) Induced Arthritis Rats via Inhibition of MAPK Signaling Pathway

“…However, long-term use of these drugs can lead to immunocompromise, bone marrow suppression, liver and kidney function damage, gastrointestinal dysfunction, and cartilage degeneration [12]. Although TNF-α inhibitors are currently the most used biological agent in the treatment of RA, they may lead to infection [13]. erefore, it is urgent to find effective drugs with low toxicity to treat RA.…”