Anti-tumor necrosis factor-α therapy may not always prevent the new onset or exacerbation of psoriatic skin lesions, according to a case series report involving patients taking the biologics for rheumatoid arthritis.
Infections, β-adrenergic blockers, or lithium were not present in any of the nine patients before the psoriasis erupted, reported Dr. Sonja Kary of Charité University Medicine Berlin, and associates (Arch. Rheum. Dis. [Epub ahead of print], Sept. 8, 2005). The diagnosis of rheumatoid arthritis was definite in all.
HLA typing revealed that one patient had HLA-Cw6, which is linked with psoriasis. Two patients had preexisting, but inactive, psoriasis. Nine patients were treated with adalimumab, etanercept, and infliximab at varying dosages for 4 days to 14 months prior to either new onset (five) or exacerbation (four). Some patients had previously received antimalarials that did not induce psoriasis.
Psoriasis vulgaris was diagnosed in six patients and pustulosis palmoplantaris in three, although pustular symptoms were present in five patients.
Withdrawing or reducing the dose of TNF-α-blocking agents led to improvement in some patients, but this approach was generally limited by the activity of the underlying rheumatoid arthritis. The severity of psoriatic symptoms was reduced when alternative anti-TNF-α agents were used.