Department of Rheumatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Mod Rheumatol Case Rep. 2023 Jan 3;7(1):9-13. doi: 10.1093/mrcr/rxac023.
Pyoderma gangrenosum (PG) is a rare chronic skin disease characterised by painful skin ulcers. There are no treatment guidelines for PG, but systemic treatments including biologics are often used. Recently, adalimumab (ADA), a fully human monoclonal antibody against tumour necrosis factor, was approved for refractory PG treatment in Japan. Herein, we report a case of rheumatoid arthritis with refractory PG 2 months after orthopaedic surgery of the foot during treatment with low-dose etanercept and methotrexate. Although adding a moderate dose of glucocorticoid did not improve her PG, the patient showed a remarkable response after switching from etanercept to ADA in a higher dose than that used to treat rheumatoid arthritis. This higher dose of ADA may be effective for the treatment of refractory PG after the failure of other tumour necrosis factor inhibitors.
坏疽性脓皮病（PG）是一种罕见的慢性皮肤疾病，其特征为疼痛性皮肤溃疡。目前尚无 PG 的治疗指南，但通常会使用包括生物制剂在内的系统治疗。最近，阿达木单抗（ADA），一种针对肿瘤坏死因子的全人源单克隆抗体，在日本被批准用于难治性 PG 的治疗。本文报告了 1 例类风湿关节炎患者，在接受低剂量依那西普和甲氨蝶呤治疗的情况下，在足部矫形手术后 2 个月发生难治性 PG。尽管增加中等剂量的糖皮质激素并未改善她的 PG，但在将依那西普转换为 ADA 治疗时，增加剂量（高于治疗类风湿关节炎的剂量）后，患者的 PG 得到了显著缓解。对于其他肿瘤坏死因子抑制剂治疗失败后的难治性 PG，较高剂量的 ADA 可能是有效的。
