Rheumatology Unit, Universidade Federal de Santa Catarina, Florianópolis, Brazil.
Rheumatol Int. 2012 May;32(5):1313-6. doi: 10.1007/s00296-011-1799-9. Epub 2011 Feb 3.
Tumoral necrosis factor alpha blockers are very efficient in the treatment of many inflammatory systemic diseases, including rheumatoid arthritis and psoriasis. However, a paradoxical arouse of psoriasiform lesions may occur in a few patients taking anti-TNFα. The etiology of this rare side effect is still a mystery, and its treatment may be difficult. The authors report the resolution of adalimumab-induced psoriasis in a woman with rheumatoid arthritis after the use of high vitamin D(3) doses for the treatment of vitamin D deficiency. This is the first report of resolution of anti-TNFα-induced psoriasiform lesions by high doses of vitamin D(3) in a patient with rheumatoid arthritis and vitamin D deficiency. This case raises interesting questions on the role of vitamin D deficiency in the pathogenesis of this side effect and on the possible usefulness of high-dose vitamin D(3) in its treatment.
肿瘤坏死因子-α 阻滞剂在治疗许多炎症性全身性疾病方面非常有效，包括类风湿关节炎和银屑病。然而，少数接受抗 TNF-α 治疗的患者可能会出现银屑病样病变的矛盾性激发。这种罕见的副作用的病因仍然是一个谜，其治疗可能很困难。作者报告了一例类风湿关节炎患者在使用大剂量维生素 D(3)治疗维生素 D 缺乏症后，因阿达木单抗引起的银屑病得到缓解。这是首例类风湿关节炎合并维生素 D 缺乏症患者因大剂量维生素 D(3)治疗而缓解抗 TNF-α 引起的银屑病样病变的报道。该病例提出了一些有趣的问题，即维生素 D 缺乏在这种副作用发病机制中的作用，以及大剂量维生素 D(3)在其治疗中的可能作用。
