Ustekinumab treatment was associated with new-onset or worsening psoriatic arthritis in a series of seven patients with psoriasis.
The findings, which support previous observations that patients treated with ustekinumab (Stelara) “sometimes have discordant responses of their skin and joint disease,” underscore the need for regularly asking patients about joint symptoms, and for referral to a rheumatologist for suspected psoriatic arthritis, Ben B. Jones of the University of Utah, Salt Lake City, and his colleagues reported (Br. J. Dermatol. 2014 Dec. 30 [doi:10.1111/bjd.13645]).
All seven patients in the case series had well-controlled psoriasis on ustekinumab. Five had new-onset psoriatic arthritis, and two had worsening psoriatic arthritis on treatment. The patients had phenotypic similarities; most were women over age 49 years, and all five of those with new-onset disease were women. Also, five of the seven patients had exposure to tumor necrosis factor inhibitors prior to switching to ustekinumab.
Three other case series have reported similar findings of marked improvement in cutaneous symptoms with worsening of joint symptoms among patients treated with ustekinumab, the investigators noted, concluding that the findings – which may reflect a lack of efficacy at the administered doses or a need for more frequent dosing – may support arguments that psoriatic arthritis and psoriasis involve distinct inflammatory pathways.
“It is also possible that ustekinumab may trigger or unmask inflammation in the joints of patients with psoriatic arthritis,” they wrote, concluding that “larger epidemiologic studies comparing patients with discordant and concordant cutaneous and articular responses to ustekinumab may better define patients at risk for psoriatic arthritis worsening with ustekinumab.”
Two of the five authors have reported serving as a consultant or advisory board member, receiving payment for lectures, and/or serving as an investigator for Janssen, which markets ustekinumab, as well as other manufacturers of biologics. The other authors reported having no conflicts of interest.