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Psoriatic arthritis (PsA) is a seronegative and chronic inflammatory arthritis that is associated with psoriasis. The standard dose of the anti-TNF monoclonal antibody adalimumab (ADA, 40 mg/2 weeks) has clinical indication for PsA, but there has been no clinical trial showing the efficacy and safety of treatment with an increased dose of ADA (80 mg/2 weeks) for PsA. Here we report the case of PsA that relapsed after discontinuation of treatment with ADA, was refractory to re-treatment with ADA (40 mg/2 weeks) and methotrexate (MTX), and was successfully treated with an increased dose of ADA (80 mg/2 weeks) with MTX. A 46-year-old man who had been diagnosed as having psoriasis at the age of 40 years and had been treated with topical corticosteroids was admitted to our hospital due to arthralgia and back pain with deterioration of psoriasis. He was diagnosed with psoriatic arthritis and was treated with 40 mg/2 weeks of ADA with MTX. After the start of treatment, he achieved remission, but he suddenly discontinued his treatment with ADA and MTX. Six months after the discontinuation of treatment, his psoriasis and arthritis deteriorated. Re-treatment with 40 mg/2 weeks of ADA with MTX did not improve his symptoms, and he was treated with an increased dose of ADA (80 mg/2 weeks) with MTX, leading to re-remission. Our case suggests that dose escalation of ADA with MTX is a potential treatment for PsA that has relapsed after discontinuation of treatment with ADA and is refractory to re-treatment with ADA (40 mg/ 2weeks) and MTX as secondary failure.

Refractory Psoriatic Arthritis Responding to an Increased Dose of the Anti-TNF Monoclonal Antibody Adalimumab