Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Scand J Rheumatol. 2009;38(5):328-31. doi: 10.1080/03009740902922612.
To describe immune-mediated skin lesion (IMSL) development in patients during anti-tumour necrosis factor (TNF) therapy.
Two hundred and fifty-two patients with rheumatoid arthritis (RA) and 183 with spondyloarthropathies (SpA) treated with anti-TNF inhibitors were analysed to identify IMSLs.
Of the 252 patients with RA (146 treated with infliximab, 72 with adalimumab, and 34 with etanercept), 32 developed IMSLs. Eleven patients developed psoriatic skin lesions, 10 presented with granuloma annulare (GA), five had skin vasculitis, two alopecia areata, two discoid lupus erythematosus, one lichenoid eruption (lichen planus), and one vitiligo. Of the 183 patients with SpA (138 treated with infliximab, 37 with etanercept, and eight with adalimumab), 10 cases with IMSLs were identified. All were treated with infliximab. More specifically, six patients with ankylosing spondylitis (AS) developed psoriatic skin lesions, one developed GA, one lichen planus, and one alopecia areata. In addition, one patient with psoriatic arthritis (PsA) developed skin vasculitis. The occurrence of these IMSLs ranged from 3 to 36 months with a median of 20 months. Of all the patients with IMSL development, two with psoriatic skin lesions, two with GA, and one with vasculitis stopped anti-TNF therapy because of the extent and severity of the skin lesions.
Our results on patients treated with TNF antagonists strongly support a link between TNF inhibition and IMSL development. Although these clinical complications are rare, clinicians should be aware of their occurrence and should recognize them.
描述肿瘤坏死因子（TNF）拮抗剂治疗过程中患者免疫介导性皮肤损伤（IMSL）的发生情况。
分析了 252 例类风湿关节炎（RA）和 183 例脊柱关节炎（SpA）患者，以识别 IMSLs。
252 例 RA 患者（146 例接受英夫利昔单抗治疗，72 例接受阿达木单抗治疗，34 例接受依那西普治疗）中有 32 例发生 IMSLs。11 例患者出现银屑病样皮肤损伤，10 例患者出现环状肉芽肿（GA），5 例患者出现皮肤血管炎，2 例患者出现斑秃，2 例患者出现盘状红斑狼疮，1 例患者出现扁平苔藓样疹，1 例患者出现白癜风。183 例 SpA 患者（138 例接受英夫利昔单抗治疗，37 例接受依那西普治疗，8 例接受阿达木单抗治疗）中有 10 例出现 IMSLs。所有患者均接受英夫利昔单抗治疗。更具体地说，6 例 AS 患者出现银屑病样皮肤损伤，1 例出现 GA，1 例出现扁平苔藓样疹，1 例出现斑秃。此外，1 例 PsA 患者出现皮肤血管炎。这些 IMSLs 的发生时间为 3 至 36 个月，中位数为 20 个月。在所有发生 IMSL 的患者中，有 2 例银屑病样皮肤损伤、2 例 GA 和 1 例血管炎患者因皮肤损伤的范围和严重程度而停止 TNF 拮抗剂治疗。
我们对接受 TNF 拮抗剂治疗的患者的研究结果强烈支持 TNF 抑制与 IMSL 发展之间存在关联。尽管这些临床并发症较为罕见，但临床医生应意识到它们的发生，并应予以识别。
