The Changing Face of Spondyloarthropathies Under TNF α Blockade
Ori Elkayam*, 1, 2, Irena Litinsky2, David Levartovsky2, Dan Caspi2
Identifiers and Pagination:Year: 2008
First Page: 53
Last Page: 57
Publisher Id: TORJ-2-53
Article History:Received Date: 26/2/2008
Revision Received Date: 25/3/2008
Acceptance Date: 8/5/2008
Electronic publication date: 14/11/2008
Collection year: 2008
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Tumor necrosis factor alpha (TNF-α ) therapy has been implicated in the development of autoimmune diseases. Our aim was to describe three patients with spondyloarthropathies who responded to infliximab, a chimeric monoclonal antibody specific for TNF-α but developed new symptoms of spondyloarthropathies. In parallel, a review of the literature on psoriasis induced by TNF-α blockers was undertaken.
The first patient had been suffering from ankylosing spondylitis (AS) for more than 12 years. Infliximab induced a remission of AS, but he developed overt Crohn's disease two years after starting treatment. The second patient had AS for more than 20 years. Infliximab had an excellent effect on his AS, but he developed palmo-plantar psoriasis a few months after initiating therapy with the drug. The third patient, whose long-term and severe psoriasis had responded to infliximab developed peripheral arthritis. A review of the literature revealed 63 cases of psoriasis induced by TNF-α blockers (33 on Infliximab, 16 on Etanercept and 14 on Adalimumab). The underlying diseases were variable, including all the spectrum of conditions for which TNF-α blockers are indicated. Patients developed psoriasis after a mean duration of treatment of 11 months. Interstingly, a substantial proportion of patients continued treatment with TNF α blockers, the psoriasis improving in a majorityof cases under topical treatment only.
While Infliximab may change the course of spondyloarthropathy, depressing the original symptoms it may uncover other occult aspects of these diseases.