Groth Daniel, Perez Maria, Treat James R, Castelo-Soccio Leslie, Nativ Simona, Weiss Pamela F, Lapidus Sivia, Perman Marissa J
Division of Pediatric Rheumatology, Goryeb Children's Hospital at Atlantic Health, Morristown, New Jersey.
Division of Pediatric Gastroenterology, Goryeb Children's Hospital at Atlantic Health, Morristown, New Jersey.
Pediatr Dermatol. 2019 Sep;36(5):613-617. doi: 10.1111/pde.13859. Epub 2019 Jun 25.
BACKGROUND/OBJECTIVES: The development of psoriasis while on tumor necrosis factor inhibitors (TNFi) 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 TNFi-induced psoriasis in patients with JIA at two pediatric centers, and psoriasis response to therapeutic modifications.
We performed retrospective chart review on patients with JIA treated with TNFi (adalimumab, etanercept, infliximab) who developed psoriasis. TNFi-induced psoriasis was defined as an incident diagnosis of psoriasis after starting a TNFi. Patients with personal histories of psoriasis prior to TNFi therapy were excluded. Following diagnosis, responses to medication changes were defined based on physician assessments.
Nine of 166 (5.4%) patients on TNFi for JIA were diagnosed with TNFi-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 TNFi had complete resolution, while four had worsening symptoms or partial improvement.
Our findings demonstrate the prevalence of TNFi-induced psoriasis in JIA at two centers. Though larger studies are needed, our data suggest discontinuation of TNFi or biologic class switching should be considered as treatment strategies in select patients.
背景/目的：在使用肿瘤坏死因子抑制剂（TNFi）治疗期间发生银屑病是治疗银屑病药物的一种矛盾效应。关于青少年特发性关节炎（JIA）中这一情况的数据较少。我们的目的是确定两个儿科中心JIA患者中TNFi诱导的银屑病的患病率，以及银屑病对治疗调整的反应。
我们对接受TNFi（阿达木单抗、依那西普、英夫利昔单抗）治疗且发生银屑病的JIA患者进行了回顾性病历审查。TNFi诱导的银屑病定义为开始使用TNFi后新发的银屑病诊断。排除在TNFi治疗前有银屑病个人史的患者。诊断后，根据医生评估确定对药物变化的反应。
166例接受TNFi治疗的JIA患者中有9例（5.4%）被诊断为TNFi诱导的银屑病。所有病例均为女性。1例有银屑病家族史。中位年龄为10岁（范围2 - 16岁）。5例（55%）患者出现头皮银屑病，其中4例（44%）伴有脱发。2例（22%）患者在换用不同类别的生物制剂后有显著改善，而3例（33%）患者在停用生物治疗后有显著改善。换用不同TNFi的5例患者中有1例完全缓解，而4例症状加重或部分改善。
我们的研究结果表明了两个中心JIA患者中TNFi诱导的银屑病的患病率。尽管需要更大规模的研究，但我们的数据表明，在部分患者中应考虑停用TNFi或更换生物制剂类别作为治疗策略。
