TNF-blocker therapy for RA may trigger psoriasis | Arthritis Information

 

 

Evidence continues to mount that so-called TNF-blockers used to treat rheumatoid arthritis (RA) may lead to psoriasis. The latest study by UK researchers adds to individual case reports of psoriasis occurring in RA patients treated with TNF blockers.

"We observed 25 cases of new-onset psoriasis in our cohort of almost 10,000 patients with rheumatoid arthritis receiving anti-TNF therapy," investigator Dr. Kimme L. Hyrich told Reuters Health. This compared to "no cases reported in our non-biologic treated control cohort."

As reported in the Annals of the Rheumatic Diseases, Hyrich of the University of Manchester and colleagues studied data on 9826 anti-TNF-treated patients and 2880 treated with so-called DMARDS (short for disease modifying anti-rheumatic drugs).

Based on the 25 psoriasis cases, the investigators calculate that the incidence rate for new-onset psoriasis was 1.04 per 1000 persons per year in the TNF-blocker cohort.

The incidence was significantly higher in patients treated with Humira (also known as adalimumab) than in those who received Enbrel (etanercept) or Remicade (infliximab).

"These findings present an interesting paradox," Hyrich pointed out, "as anti-TNF therapies are very effective in the treatment of severe psoriasis and psoriatic arthritis. The explanation behind these reported cases remains largely unknown."

"Further observation to understand their etiology is required," she concluded, "before any definite conclusions regarding the association between anti-TNF therapies and psoriasis can be made or guidelines for specific treatment of the condition issued."

SOURCE: Annals of the Rheumatic Diseases, February 2009.

I wonder if people who start to take it for psoriasis ever end up with RA?

I've been seeing a new ad that says if you have had psoriasis and also have joint pain, you might have PsA.  It seems like your dr. would have figured that out? 

 I happen to be one of the odd ones - never had skin psoriasis but I have PsA diagnosed by xrays of my fingers.   Not everyone has large, scaling psoriasis.  Some have very small patches in their hair, behind the ear, or in other places that aren't apparent that it's psoriasis.  Many times they're treated for other skin diseases and not psoriasis.  The most definitive tool is xrays of the digits.  There will be a deformity of the bone that only shows in PsA.  Labs are almost always normal.  It's not an easy disease to diagnose.  No two individuals have the same symptoms.  So far I haven't had skin psoriasis with the TNF but it could happen.  Lindy

Thanks for the information Lindy [QUOTE=LinB]

 I happen to be one of the odd ones - never had skin psoriasis but I have PsA diagnosed by xrays of my fingers.   Not everyone has large, scaling psoriasis.  Some have very small patches in their hair, behind the ear, or in other places that aren't apparent that it's psoriasis.  Many times they're treated for other skin diseases and not psoriasis.  The most definitive tool is xrays of the digits.  There will be a deformity of the bone that only shows in PsA.  Labs are almost always normal.  It's not an easy disease to diagnose.  No two individuals have the same symptoms.  So far I haven't had skin psoriasis with the TNF but it could happen.  Lindy

[/QUOTE]

More than one rheum thought my daughter could have PsA - she was asymetrical and had a sausage digit.  But then they all said it wasn't, because no family member has psoriasis (apparently, even if you don't have it, they believe at least a relative would).

For about two years, I took her to the dr. for every rash that came up, but all they would ever say is, "Well, it's not psoriasis".  So now when she gets a mystery rash, we call it Notpsoriasis!  And save the co-pay LOL.

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