title: Paradoxical psoriasis after the use of anti-TNF in a patient with rheumatoid arthritis.
abstract: The use of tumor necrosis factor antagonists (anti-TNF) has become a usual practice to treat various inflammatory diseases. Although indicated for the treatment of psoriasis, anti-TNF may paradoxically trigger a psoriasiform condition. We present a case of a female patient who, during the use of infliximab for rheumatoid arthritis, developed psoriasis. In an attempt to switch anti-TNF class, we observed a cumulative worsening of the lesions requiring suspension of the immunobiological agent and the introduction of other drugs for clinical control. The therapeutic challenge of this paradoxical form of psoriasis is the focus of our discussion. The use of another anti-TNF in these patients is a matter of debate among experts.
authors.affiliation: Universidade do Estado do Rio de Janeiro (Uerj) - Rio de Janeiro (RJ), Brazil.
authors.forename: Jaqueline Barbeito de
authors.initials: JB
authors.lastname: Vasconcellos
authors.affiliation: Universidade do Estado do Rio de Janeiro (Uerj) - Rio de Janeiro (RJ), Brazil.
authors.forename: Daniele do Nascimento
authors.initials: DD
authors.lastname: Pereira
authors.affiliation: Hospital Geral de Bonsucesso (HGB) - Rio de Janeiro (RJ), Brazil.
authors.forename: Thiago Jeunon de Sousa
authors.initials: TJ
authors.lastname: Vargas
authors.affiliation: Universidade do Estado do Rio de Janeiro (Uerj) - Rio de Janeiro (RJ), Brazil.
authors.forename: Roger Abramino
authors.initials: RA
authors.lastname: Levy
authors.affiliation: Universidade do Estado do Rio de Janeiro (Uerj) - Rio de Janeiro (RJ), Brazil.
authors.forename: Geraldo da Rocha Castelar
authors.initials: GD
authors.lastname: Pinheiro
authors.affiliation: Universidade do Estado do Rio de Janeiro (Uerj) - Rio de Janeiro (RJ), Brazil.
authors.forename: Ígor Brum
authors.initials: ÍB
authors.lastname: Cursi
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects*; D011565:Psoriasis / Q000139:chemically induced* / Q000473:pathology*; D012867:Skin / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab