Crohn's and Colitis Center, Massachusetts General Hospital, Boston, USA.
Aliment Pharmacol Ther. 2011 Dec;34(11-12):1318-27. doi: 10.1111/j.1365-2036.2011.04866.x. Epub 2011 Sep 29.
BACKGROUND Anti-tumour necrosis factor (TNF) antibodies are used to treat both psoriasis and inflammatory bowel disease. The seemingly paradoxical occurrence of psoriasis in patients treated with anti-TNF antibodies is increasingly recognised, but the distinct features associated with inflammatory bowel disease have been incompletely characterised. AIM To identify inflammatory bowel disease patients who developed psoriasis while receiving an anti-TNF antibody at two academic medical centres between 2000 and 2009 and review all published cases of this phenomenon in inflammatory bowel disease. METHODS We identified retrospectively all cases of anti-TNF-induced psoriasis in inflammatory bowel disease patients attending two North American healthcare centres. We analysed these cases alongside the published reports of anti-TNF-induced psoriasis. RESULTS We identified 30 subjects who developed a psoriatic rash while receiving anti-TNF therapy for inflammatory bowel disease. Forty-seven per cent (14/30) responded to topical therapy and 23% (7/30) ultimately discontinued the anti-TNF. The new data were combined with those from 120 published cases of anti-TNF-induced psoriasis in inflammatory bowel disease. Anti-TNF-induced psoriasis in inflammatory bowel disease was more common in women (70%). The most common distributions were palmoplantar (43%) and scalp (42%). Complete follow-up in 148 cases showed that 41% responded to topical therapy but 43% required definitive withdrawal of anti-TNF therapy due to the rash. A second anti-TNF was tried in 27 cases with recurrence or persistence of the rash in 14 (52%). CONCLUSIONS In this analysis, psoriasiform lesions related to anti-TNF therapy in inflammatory bowel disease occurred most commonly in women. Approximately 41% of those who developed psoriasis while on anti-TNFs responded to topical therapy and were able to continue the drug, while 52% of those treated with an alternate anti-TNF had recurrence of the rash.
抗肿瘤坏死因子（TNF）抗体被用于治疗银屑病和炎症性肠病。在接受抗 TNF 抗体治疗的患者中，银屑病的发生似乎是矛盾的，这种现象越来越受到关注，但与炎症性肠病相关的独特特征尚未得到充分描述。目的：在 2000 年至 2009 年期间，在两个学术医疗中心，确定接受抗 TNF 抗体治疗的炎症性肠病患者中出现银屑病的患者，并回顾炎症性肠病中出现这种现象的所有已发表病例。方法：我们回顾性地确定了在两个北美医疗中心接受抗 TNF 治疗的炎症性肠病患者中出现抗 TNF 诱导性银屑病的所有病例。我们分析了这些病例以及已发表的抗 TNF 诱导性银屑病病例报告。结果：我们确定了 30 名患者在接受抗 TNF 治疗炎症性肠病时出现银屑病皮疹。47%（14/30）对局部治疗有反应，23%（7/30）最终停用了抗 TNF。新数据与 120 例已发表的炎症性肠病中抗 TNF 诱导性银屑病的病例相结合。在炎症性肠病中，抗 TNF 诱导性银屑病在女性中更为常见（70%）。最常见的分布是掌跖部（43%）和头皮（42%）。对 148 例的完整随访显示，41%的患者对局部治疗有反应，但由于皮疹，43%的患者需要停用抗 TNF 治疗。在 27 例尝试使用第二种抗 TNF 药物的病例中，有 14 例（52%）皮疹复发或持续存在。结论：在本分析中，与炎症性肠病抗 TNF 治疗相关的银屑病样病变最常见于女性。约 41%的患者在接受抗 TNF 治疗时出现银屑病，对局部治疗有反应，能够继续使用该药，而 52%的患者在改用其他抗 TNF 治疗后皮疹复发。
