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Development of systemic lupus erythematosus in psoriatic patient after etanercept transition to Infliximab
Date Issued |
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2018-10-04 |
Bibliogr.: p. 62
Introduction. Tumor necrosis factor (TNF) alfa antagonists are licensed as a first line biologic therapy for severe inflammatory diseases including psoriasis [1, 2]. Up until 2017 only 254 patients who developed TNF alfa antagonist - induced lupus or lupus like syndrome were reported. It occurred more frequently in patients with rheumatoid arthritis (52%) and rarely in patient with psoriasis (9%). TNF alfa antagonist - induced lupus developed more often in patients treated with more immunogenic drug, chimeric monoclonal antibody – infliximab (59%) vs. fusion protein - etanercept (28%) and fully humanized monoclonal antibody - adalimumab (12%) [3]. Case report. A 51-year-old female with severe chronic plaque psoriasis and psoriatic arthritis had her treatment switched to infliximab (5 mg/kg, every 8 week) when she developed failure to etanercept (50 mg twice a week) and methotrexate (10 mg/week) after one year. Her baseline antinuclear antibodies (ANA) were negative. Six months later the patient developed worsening of skin condition as well as arthritis of elbows and knees, subfebrile temperature, thrombocytopenia, positive ANA 1:100 (with homogenous pattern 3+), positive double stranded DNA (dsDNA) 22.12 kU/l (normal < 12 kU/l), and idiopatic splenomegaly. Infective etiologies and haematological disease were excluded. The diagnosis of infliximab - induced lupus was made according to American College of Rheumatology criteria for TNF alfa induced lupus [3]. Nine months after infliximab cessation and usage of prednisolone (30 mg reducing course over 2 month), her ANA and dsDNA antibodies were negative. The worsening of skin condition was clinically evaluated as the exacerbation of severe plaque psoriasis. After 2 years the patient started interleukin 12/23 inhibitor - ustekinumab with a good clinical effect. [...].