title: The efficacy of adalimumab in psoriatic arthritis concomitant to overlapping primary biliary cholangitis and primary sclerosing cholangitis: a case report.
abstract: The overlap syndrome of primary biliary cholangitis (formerly called primary biliary cirrhosis) and primary sclerosing cholangitis is an extremely rare condition that has never been described in association with other immune-mediated diseases, including psoriatic arthritis. While treatment with anti-Tumour Necrosis Factor-alpha (TNF-α) agents has proved to be effective in inflammatory arthropathies such as psoriatic arthritis, they have been employed in only a limited number of patients with autoimmune hepatitis, and their effectiveness is unclear.
  
  
  
  We report the case of a 51-year-old female affected with psoriatic arthritis concomitant to overlapping primary biliary cholangitis and primary sclerosing cholangitis in whom 28 months of adalimumab treatment improved the symptoms of the inflammatory arthropathy as well as those of both cholangiopathies.
  
  
  
  Our results suggest that further studies examining the therapeutic role of this particular TNF-α blocker are warranted in cholestatic autoimmune hepatitis patients, and in particular in those individuals in whom the disease is associated with inflammatory arthropathies.
authors.affiliation: Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy. teresa.delross@sanita.padova.it.
authors.forename: Teresa
authors.initials: T
authors.lastname: Del Ross
authors.affiliation: Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy.
authors.forename: Amelia
authors.initials: A
authors.lastname: Ruffatti
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.
authors.forename: Annarosa
authors.initials: A
authors.lastname: Floreani
authors.affiliation: Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy.
authors.forename: Ariela
authors.initials: A
authors.lastname: Hoxha
authors.affiliation: Rheumatology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000150:complications* / Q000188:drug therapy; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged
chemical_list: D000893:Anti-Inflammatory Agents; D000068879:Adalimumab
keywords: Anti-TNF-alpha drugs; Primary biliary cirrhosis; Primary sclerosing cholangitis; Psoriatic arthritis