ABSTRACT
TNF-alpha antagonists have been successfully utilized in the treatment of autoimmune diseases, including psoriasis and psoriatic arthritis. Paradoxically, new onset or exacerbation of psoriatic lesions during treatment with TNF-alpha antagonists have been reported. It has been postulated that TNF-alpha blockade may cause disruption in the balance between TNF-alpha and type 1 interferon (IFN)-alpha, which are the key players in the pathogenesis of psoriasis. We report a case of psoriasis exacerbation during TNF-alpha antagonist therapy in a 53-years-old man with ankylosing spondylitis. The patient has been treated with etanercept for 3 years and 7 months when he developed accelerated deterioration of psoriasis. His condition was previously under control solely by local treatment. Physical examination revealed vigorous desquamative lesions with silvery scale in both lower legs. Deterioration of psoriasis was attributed to etanercept therapy and was subsequently discontinued. Clinical improvement of psoriasis has been observed 2 months following cessation of etanercept.
Subject(s)
Humans , Arthritis, Psoriatic , Autoimmune Diseases , Etanercept , Immunoglobulin G , Interferons , Leg , Physical Examination , Psoriasis , Receptors, Tumor Necrosis Factor , Skin , Spondylitis, Ankylosing , Tumor Necrosis Factor-alphaABSTRACT
OBJECTIVE: We wanted to investigate the incidence of serious infections among the rheumatoid arthritis (RA) patients who were treated with tumor necrosis factor alpha (TNF-alpha) antagonists. METHODS: We enrolled the 175 RA patients who were treated with TNF-alpha antagonists for at least 3 months during February 2003 to July 2008, and these patients were in the SMART-b cohort of Kangnam St. Mary's hospital. Patients were prescribed infliximab, etanercept or adalimumab. The data was retrospectively collected. RESULTS: The incidence of serious infections among the RA patients treated with TNF-alpha was significantly increased according to the survival analysis, as compared with that of those patient treated with conventional DMARDs (p<0.01). The most common serious infection was pneumonia. There was no significant difference in the incidence of serious infections among the three TNF-alpha antagonists used in this study (p=0.96). But the serious infections occurred more often in the patients who received more than 10 mg methotrexate (MTX) per week (p=0.02). CONCLUSION: RA patients treated with TNF-alpha antagonists had a higher incidence of serious infection. Therefore, close monitoring for serious infection is needed for RA patients who are receiving TNF-alpha antagonists.
Subject(s)
Humans , Antibodies, Monoclonal , Antibodies, Monoclonal, Humanized , Antirheumatic Agents , Arthritis, Rheumatoid , Cohort Studies , Immunoglobulin G , Incidence , Methotrexate , Pneumonia , Receptors, Tumor Necrosis Factor , Retrospective Studies , Tumor Necrosis Factor-alphaABSTRACT
OBJECTIVE: We wanted to investigate the incidence of serious infections among the rheumatoid arthritis (RA) patients who were treated with tumor necrosis factor alpha (TNF-alpha) antagonists. METHODS: We enrolled the 175 RA patients who were treated with TNF-alpha antagonists for at least 3 months during February 2003 to July 2008, and these patients were in the SMART-b cohort of Kangnam St. Mary's hospital. Patients were prescribed infliximab, etanercept or adalimumab. The data was retrospectively collected. RESULTS: The incidence of serious infections among the RA patients treated with TNF-alpha was significantly increased according to the survival analysis, as compared with that of those patient treated with conventional DMARDs (p<0.01). The most common serious infection was pneumonia. There was no significant difference in the incidence of serious infections among the three TNF-alpha antagonists used in this study (p=0.96). But the serious infections occurred more often in the patients who received more than 10 mg methotrexate (MTX) per week (p=0.02). CONCLUSION: RA patients treated with TNF-alpha antagonists had a higher incidence of serious infection. Therefore, close monitoring for serious infection is needed for RA patients who are receiving TNF-alpha antagonists.