Kutlu Ömer, Çetinkaya Pınar, Şahin Tijen, Ekşioğlu Hatice Meral
Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Turkey.
Department of Dermatology and Venereology, Aydın Nazilli State Hospital, Turkey.
Indian Dermatol Online J. 2020 Nov 8;11(6):904-909. doi: 10.4103/idoj.IDOJ_164_20. eCollection 2020 Nov-Dec.
Biological agents are being used as treatment of psoriasis for years. However, autoimmunity can develop after the using of these agents. Antinuclear antibody (ANA) status changes during biological therapy can be affected by certain factors including the presence of immunosuppression. We aimed to evaluate the effect of antitumor necrosis factor agents and ustekinumab on ANA status, as well as other factors leading to change in ANA status such as history of phototherapy and methotrexate combination therapy.
In this study, the laboratory findings of thirty-one patients with psoriasis who received biological agents including infliximab, etanercept, adalimumab, and ustekinumab from 2016 to 2018 managed at the department of dermatology were reviewed. The ANA status of the patients was evaluated every 2-3 months.
Twelve (38.7%) out of the thirty-one patients developed ANA positivity during treatment. Nine patients receiving infliximab, two patients receiving etanercept, and one patient receiving adalimumab developed ANA positivity. The nuclear homogeneous, nuclear fine speckled, and nuclear large/coarse speckled were the most common patterns of ANA. A patient receiving infliximab also developed anti-dsDNA positivity. None of the patients developed drug-induced lupus erythematosus or any autoimmune diseases. Concomitant methotrexate use and phototherapy history had no effect on ANA status statistically ( = 0.240 and 0.717, respectively).
The emergence of ANA positivity during infliximab therapy among all biological agents was more common. ANA positivity during biologic agents does not cause any signs and symptoms of autoimmune diseases in patients with psoriasis; thus, it can be suggested that biological agents are not major risk factors for autoimmunity.
生物制剂多年来一直用于治疗银屑病。然而，使用这些制剂后可能会发生自身免疫。生物治疗期间抗核抗体（ANA）状态的变化可能受某些因素影响，包括免疫抑制的存在。我们旨在评估抗肿瘤坏死因子制剂和乌司奴单抗对ANA状态的影响，以及导致ANA状态变化的其他因素，如光疗史和甲氨蝶呤联合治疗。
在本研究中，回顾了2016年至2018年在皮肤科接受包括英夫利昔单抗、依那西普、阿达木单抗和乌司奴单抗在内的生物制剂治疗的31例银屑病患者的实验室检查结果。每2 - 3个月评估患者的ANA状态。
31例患者中有12例（38.7%）在治疗期间出现ANA阳性。9例接受英夫利昔单抗治疗的患者、2例接受依那西普治疗的患者和1例接受阿达木单抗治疗的患者出现ANA阳性。核均质型、核细颗粒型和核大/粗颗粒型是ANA最常见的模式。1例接受英夫利昔单抗治疗的患者还出现了抗双链DNA阳性。所有患者均未发生药物性红斑狼疮或任何自身免疫性疾病。同时使用甲氨蝶呤和光疗史对ANA状态无统计学影响（分别为 = 0.240和0.717）。
在所有生物制剂中，英夫利昔单抗治疗期间ANA阳性的出现更为常见。生物制剂治疗期间ANA阳性在银屑病患者中未引起任何自身免疫性疾病的体征和症状；因此，可以认为生物制剂不是自身免疫的主要危险因素。
