Paradoxically Psoriasis, developed in a patient using adalimumab for ankylosing spondylitis: Case report

Irkin, Sena; Çelik, Neşe Çabuk; Karakaş, Burak; Karataş, B.; Şahin, Ali

doi:10.7197/cmj.842870

Cumhuriyet Medical Journal

2021

DOI: 10.7197/cmj.842870

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Paradoxically Psoriasis, developed in a patient using adalimumab for ankylosing spondylitis: Case report

Sena Irkin¹,

Neşe Çabuk Çelik²,

Burak Karakaş³

et al.

Abstract: Anti-tumor necrosis factor agents are effective drugs for inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. Although it is indicated for the treatment of Ankylosing Spondylitis, there are recent publications about paradoxical side effects due to these agents, mostly in the form of case reports. In this article, we present the psoriasis case that develops paradoxically in a patient with ankylosing spondylitis using adalimumab.

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2023

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Paradoxical Tumor Necrosis Factor-Alpha (TNF-α) Inhibitor-Induced Psoriasis: A Systematic Review of Pathogenesis, Clinical Presentation, and Treatment

Chokshi,

Demory Beckler,

Laloo

et al. 2023

Cureus

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Tumor necrosis factor-alpha (TNF-α) inhibitors have been shown to be well tolerated among patients with rheumatoid arthritis, inflammatory bowel disease, and psoriasis. Meanwhile, more recently, clinical practice and research efforts have uncovered increasing cases of psoriatic lesion development tied to initiating treatment with a TNF-α inhibitor. The underlying mechanisms associated with this occurrence have yet to be fully elucidated. A review and analysis of cases of paradoxical psoriasis currently published in the literature is warranted. In addition, exploring possible mechanisms of action and potential treatment options associated with favorable outcomes is much needed.A systematic literature review was performed utilizing PubMed and Google Scholar databases (1992present), in which 106 cases of paradoxical psoriasis were reviewed. The most common morphology developed was plaque psoriasis vulgaris. There was a female predominance (61.3%), and the most common underlying autoimmune disease was rheumatoid arthritis (45.3%). In addition, the most commonly associated drug with the onset of psoriatic lesions was infliximab (62.3%). Furthermore, the findings suggest that the most well-supported mechanism of action involves the uncontrolled release of interferon-alpha (IFN-α) from plasmacytoid dendritic cells (pDCs) after TNF-α inhibition. While TNF-α inhibitors have been shown to have great benefits to patients with rheumatologic diseases, cases of paradoxical psoriasis demonstrate the importance of close monitoring of patients on TNF-α inhibitors to allow for early recognition, treatment, and potentially change to a different mechanism of action of the medication used to prevent further progression of the inflammatory lesions.

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Paradoxical Tumor Necrosis Factor-Alpha (TNF-α) Inhibitor-Induced Psoriasis: A Systematic Review of Pathogenesis, Clinical Presentation, and Treatment

Chokshi,

Demory Beckler,

Laloo

et al. 2023

Cureus

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show abstract

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Paradoxically Psoriasis, developed in a patient using adalimumab for ankylosing spondylitis: Case report

Cited by 1 publication

References 5 publications

Paradoxical Tumor Necrosis Factor-Alpha (TNF-α) Inhibitor-Induced Psoriasis: A Systematic Review of Pathogenesis, Clinical Presentation, and Treatment

Paradoxical Tumor Necrosis Factor-Alpha (TNF-α) Inhibitor-Induced Psoriasis: A Systematic Review of Pathogenesis, Clinical Presentation, and Treatment

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