title: Long-term ustekinumab therapy of psoriasis in patients with coexisting rheumatoid arthritis and Sjögren syndrome. Report of two cases and review of literature.
abstract: BACKGROUND
  Inteleukin (IL)12 and IL23 are two main cytokines involved in the pathogenesis of immune-mediated disease. IL12 is produced by macrophages and B lymphocytes and mediates differentiation of Th1 lymphocytes, while IL23 is a pro-inflammatory cytokine essential for the differentiation of Th17 cells. Ustekinumab is a human monoclonal antibody directed against the p40 protein subunit shared by IL12 and IL23, therefore it blocks the signal transmission of both cytokines.
  
  
  METHODS
  We present two cases and discuss the long-term efficacy of ustekinumab as a treatment of psoriasis in patients affected by autoimmune diseases, rheumatoid arthritis and Sjögren's syndrome, who presented with severe psoriasis after anti-TNF treatment.
  
  
  CONCLUSIONS
  To the best of our knowledge, these are the first cases reported in the literature describing the long-term good efficacy of ustekinumab not only on paradoxical forms of psoriasis induced by anti-TNF-α drugs, but also on the articular involvement in a patient affected by RA and in a patient affected by Sjögren syndrome.
authors.affiliation: Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata";
authors.forename: Maria Sole
authors.initials: MS
authors.lastname: Chimenti
authors.affiliation: Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata".
authors.forename: Marina
authors.initials: M
authors.lastname: Talamonti
authors.affiliation: Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata";
authors.forename: Lucia
authors.initials: L
authors.lastname: Novelli
authors.affiliation: Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata".
authors.forename: Miriam
authors.initials: M
authors.lastname: Teoli
authors.affiliation: Dermatology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata".
authors.forename: Marco
authors.initials: M
authors.lastname: Galluzzo
authors.affiliation: Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata";
authors.forename: Paola
authors.initials: P
authors.lastname: Triggianese
authors.affiliation: Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata";
authors.forename: Roberto
authors.initials: R
authors.lastname: Perricone
keywords: Sjögren's syndrome; Ustekinumab; autoimmune diseases; psoriasis; rheumatoid arthritis