title: Successful effect of tocilizumab in anti-TNF-α-induced palmoplantar pustulosis in rheumatoid arthritis.
abstract: Anti-tumour necrosis factor-alpha (TNF-α) agents are effective drugs used in several chronic inflammatory diseases such as rheumatoid arthritis (RA). Psoriasiform lesions, including palmoplantar pustulosis, have been described following anti-TNF-α therapy. These lesions often resolve with topical therapy with or without discontinuation of these drugs. However, in some cases, psoriasiform lesions may persist despite anti-TNF-α withdrawal. We report on two RA patients treated with adalimumab (ADA) who developed palmoplantar pustular despite dermatological treatment and ADA discontinuation. Tocilizumab (TCZ) therapy was initiated because of persistence of skin lesions and flare of the disease. Following treatment with this drug, complete resolution of the dermatological lesions and induction of remission of RA was achieved. To the best of our knowledge, management of palmoplantar pustulosis due to TNF-α agents with TCZ leading to both improvement of the disease and resolution of the cutaneous lesions has not previously been reported.
authors.affiliation: Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain. ruedagotor@gmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Rueda-Gotor
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco Alonso
authors.forename: Carmen
authors.initials: C
authors.lastname: Gonzalez-Vela
authors.forename: Cristina
authors.initials: C
authors.lastname: Lopez-Obregon
authors.forename: Marcos A
authors.initials: MA
authors.lastname: González-López
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000494:pharmacology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors / Q000187:drug effects; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; C502936:tocilizumab