title: Treatment of coexistent psoriasis and lupus erythematosus.
abstract: BACKGROUND
  The coexistence of psoriasis and lupus erythematosus (LE) is rare. Anecdotal evidence suggests that anti-tumor necrosis factor alfa (TNF-α) agents may be efficacious in LE, although their use is commonly avoided in this disease because of concern for lupus flare.
  
  
  OBJECTIVE
  We sought to describe the epidemiology, serologic findings, and therapeutic choices in patients with coexistent psoriasis/psoriatic arthritis and LE and to determine the risk of lupus flares with TNF-α inhibitors.
  
  
  METHODS
  We performed a retrospective multicenter study of patients given the diagnoses of psoriasis (or psoriatic arthritis) and lupus erythematosus (systemic LE or cutaneous LE, including either subacute cutaneous LE or discoid LE) at 2 academic tertiary-care centers.
  
  
  RESULTS
  A total of 96 patients with a mean age of 56 years was included. We report higher-than-expected rates of white race and psoriatic arthritis. One clinical lupus flare was observed in a patient receiving a TNF-α inhibitor, resulting in an incidence of 0.92% lupus flares per patient-year of TNF-α inhibitor use.
  
  
  CONCLUSIONS
  Retrospective chart review, small sample size, and limited documentation.
  
  
  CONCLUSIONS
  Anti-TNF-α agents, ustekinumab, and abatacept may be valid treatment options for patients with concomitant LE and psoriasis. Clinical lupus flares in LE patients treated with TNF-α inhibitors were infrequent.
authors.affiliation: Department of Dermatology, Tufts University Medical Center, Boston, Massachusetts; Jefferson Medical College, Philadelphia, Pennsylvania.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Varada
authors.affiliation: Department of Dermatology, Tufts University Medical Center, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Alice B
authors.initials: AB
authors.lastname: Gottlieb
authors.affiliation: Department of Dermatology and Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Merola
authors.affiliation: Department of Dermatology, Tufts University Medical Center, Boston, Massachusetts.
authors.forename: Ami R
authors.initials: AR
authors.lastname: Saraiya
authors.affiliation: Department of Dermatology, Tufts University Medical Center, Boston, Massachusetts. Electronic address: suzanne.tintle@gmail.com.
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Tintle
mesh_terms: D000069594:Abatacept; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D018796:Immunoconjugates / Q000627:therapeutic use*; D008178:Lupus Erythematosus, Cutaneous / Q000150:complications* / Q000188:drug therapy*; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D000069549:Ustekinumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018796:Immunoconjugates; D014409:Tumor Necrosis Factor-alpha; D000069594:Abatacept; D000069549:Ustekinumab
keywords: lupus erythematosus; psoriasis; tumor necrosis factor alfa