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Tumor necrosis factor‐α inhibitor‐induced psoriasis in juvenile idiopathic arthritis patients
Author(s) -
Groth Daniel,
Perez Maria,
Treat James R.,
CasteloSoccio Leslie,
Nativ Simona,
Weiss Pamela F.,
Lapidus Sivia,
Perman Marissa J.
Publication year - 2019
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.13859
Subject(s) - psoriasis , medicine , etanercept , adalimumab , infliximab , discontinuation , arthritis , tumor necrosis factor alpha , dermatology , tnf inhibitor
Background/Objectives The development of psoriasis while on tumor necrosis factor inhibitors ( TNF i) is a paradoxical effect of agents that treat psoriasis. There is a paucity of data available on this entity in juvenile idiopathic arthritis ( JIA ). Our objectives were to determine the prevalence of TNF i‐induced psoriasis in patients with JIA at two pediatric centers, and psoriasis response to therapeutic modifications. Methods We performed retrospective chart review on patients with JIA treated with TNF i (adalimumab, etanercept, infliximab) who developed psoriasis. TNF i‐induced psoriasis was defined as an incident diagnosis of psoriasis after starting a TNF i. Patients with personal histories of psoriasis prior to TNF i therapy were excluded. Following diagnosis, responses to medication changes were defined based on physician assessments. Results Nine of 166 (5.4%) patients on TNF i for JIA were diagnosed with TNF i‐induced psoriasis. All cases were female. One had a family history of psoriasis. The median age was 10 (range 2‐16) years. Five (55%) patients experienced scalp psoriasis, including four (44%) with alopecia. Two (22%) patients achieved significant improvement after switching to different classes of biologic agents, while three (33%) patients had significant improvement following discontinuation of biologic therapy. One of five patients who switched to a different TNF i had complete resolution, while four had worsening symptoms or partial improvement. Conclusions Our findings demonstrate the prevalence of TNF i‐induced psoriasis in JIA at two centers. Though larger studies are needed, our data suggest discontinuation of TNF i or biologic class switching should be considered as treatment strategies in select patients.