Unmasking of axial spondyloarthritis and oligoarthritis following discontinuation of tumour necrosis factor inhibitor therapy for psoriasis.
Psoriatic arthritis remains a common cause of morbidity in patients with psoriasis. Little is known about the natural history of the disease and dermatologists do not consistently screen for its presence. We describe a patient with severe psoriasis where long-term biologic therapy with a tumour necrosis factor inhibitor was interrupted for clinical reasons, leading to a rapidly evolving axial spondyloarthritis and oligoarthritis. This unusual presentation of psoriatic arthritis may reflect masking of the disease by long-term treatment with a tumour necrosis factor inhibitor. We advocate the use of screening for psoriatic arthritis, including before and during treatment with biologic therapies.
Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.
Amy C
AC
Foulkes
Christopher E M
CE
Griffiths
Hector
H
Chinoy
Richard B
RB
Warren
D000068879:Adalimumab; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000175:diagnosis*; D016572:Cyclosporine / Q000627:therapeutic use; D057915:Drug Substitution / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007718:Knee Injuries / Q000150:complications; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D020370:Osteoarthritis, Knee / Q000175:diagnosis*; D011565:Psoriasis / Q000188:drug therapy*; D025241:Spondylarthritis / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D000069549:Ustekinumab; D028761:Withholding Treatment
D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D000069549:Ustekinumab; D000068879:Adalimumab; D008727:Methotrexate