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CASE REPORT
The immunological implications of paradoxical reactions in rheumatoid arthritis and psoriasis treatment: A case report
1
College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, SAUDI ARABIA
2
Department of Dermatology, King Fahad Hospital of the University, Al Khobar, SAUDI ARABIA
3
Department of Pathology, King Fahad Hospital of the University, Al Khobar, SAUDI ARABIA
4
Division of Rheumatology, Department of Internal Medicine, King Fahad Hospital of the University, Al Khobar, SAUDI ARABIA
Online publication date: 2024-10-24
Publication date: 2024-11-01
Electron J Gen Med 2024;21(6):em610
KEYWORDS
ABSTRACT
Psoriasis and rheumatoid arthritis (RA) are common chronic diseases with distinctive histological and molecular features. However, there are similarities in their immunological pathogenesis, leading to the use of some similar systemic biological treatment. In 5% of patients using biological therapy such as the anti-tumor necrosis factor alpha (anti-TNF-α), a paradoxical reaction (i.e., the exacerbation or development of one disease while treating the other) may develop. We report a case of a 27-year-old female diagnosed with seropositive RA who developed paradoxical psoriasis (PP) after the use of Adalimumab, an anti-TNF-α, and paradoxical eczema due to the use of Ixekizumab, an anti-interleukin-17A, for the treatment of PP. This case demonstrates the occurrence of two different types of paradoxical skin reactions in a single patient. This case also highlights the importance of the selection and cessation of biological treatment in similar cases, as well as the factors that might predict the development of paradoxical reactions to promote the safe usage of biological therapy.
REFERENCES (27)
1.
Song A, Lee SE, Kim JH. Immunopathology and immunotherapy of inflammatory skin diseases. Immune Netw. 2022;22(1):e7. https://doi.org/10.4110/in.202... PMid:35291649 PMCid:PMC8901701.
2.
Ding Q, Hu W, Wang R, et al. Signaling pathways in rheumatoid arthritis: Implications for targeted therapy. Signal Transduct Target Ther. 2023;17;8(1):68. https://doi.org/10.1038/s41392... PMid:36797236 PMCid:PMC9935929.
3.
Guttman-Yassky E, Krueger JG, Lebwohl MG. Systemic immune mechanisms in atopic dermatitis and psoriasis with implications for treatment. Exp Dermatol. 2018;27(4):409-17. https://doi.org/10.1111/exd.13... PMid:28266782.
4.
Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: Pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018;6:15. https://doi.org/10.1038/s41413... PMid:29736302 PMCid:PMC5920070.
5.
Joulfayan H, Makunts T, Abagyan R. Anti-TNF-α therapy induced psoriasis in rheumatoid arthritis patients according to FDA postmarketing surveillance data. Sci Rep. 2023;13(1):10448. https://doi.org/10.1038/s41598... PMid:37369753 PMCid:PMC10300095.
6.
Victor FC, Gottlieb AB, Menter A. Changing paradigms in dermatology: Tumor necrosis factor alpha (TNF-alpha) blockade in psoriasis and psoriatic arthritis. Clin Dermatol. 2003;21(5):392-7. https://doi.org/10.1016/j.clin... PMid:14678719.
7.
Ogawa E, Sato Y, Minagawa A, Okuyama R. Pathogenesis of psoriasis and development of treatment. J Dermatol. 2018; 45(3):264-72. https://doi.org/10.1111/1346-8... PMid:29226422.
8.
Farrugia M, Baron B. The role of TNF-α in rheumatoid arthritis: A focus on regulatory T cells. J Clin Transl Res. 2016;2(3):84-90. https://doi.org/10.18053/jctre... PMid:30873466 PMCid:PMC6410649.
9.
Gottlieb AB, Masud S, Ramamurthi R, et al. Pharmacodynamic and pharmacokinetic response to anti-tumor necrosis factor-alpha monoclonal antibody (infliximab) treatment of moderate to severe psoriasis vulgaris. J Am Acad Dermatol. 2003;48(1):68-75. https://doi.org/10.1067/mjd.20... PMid:12522373.
10.
Jin J, Chang Y, Wei W. Clinical application and evaluation of anti-TNF-alpha agents for the treatment of rheumatoid arthritis. Acta Pharmacol Sin. 2010;31(9):1133-40. https://doi.org/10.1038/aps.20... PMid:20711219 PMCid:PMC4002310.
11.
Tsiogka A, Liakou AI, Agiasofitou E, et al. Adalimumab-induced paradoxical psoriasis treated with biologics targeting the IL-17/IL-23 axis in patients with hidradenitis suppurativa. Dermatol Basel Switz. 2023;239(6):937-41. https://doi.org/10.1159/000533... PMid:37579735.
12.
Pugliese D, Guidi L, Ferraro PM, et al. Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti-TNF alpha: 5-year follow-up study. Aliment Pharmacol Ther. 2015;42(7):880-8. https://doi.org/10.1111/apt.13... PMid:26235565.
13.
Zhou Q, Zhou S, Xiong H, et al. A case of paradoxical reactions to biologic therapy for psoriasis. Clin Cosmet Investig Dermatol. 2023;16:1493-7. https://doi.org/10.2147/CCID.S... PMid:37333515 PMCid:PMC10275371.
14.
Ramos-Casals M, Roberto-Perez-Alvarez, Diaz-Lagares C, Cuadrado MJ, Khamashta MA, BIOGEAS Study Group. Autoimmune diseases induced by biological agents: A double-edged sword? Autoimmun Rev. 2010;9(3):188-93. https://doi.org/10.1016/j.autr... PMid:19854301.
15.
Collamer AN, Guerrero KT, Henning JS, Battafarano DF. Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: A literature review and potential mechanisms of action. Arthritis Rheum. 2008;59(7):996-1001. https://doi.org/10.1002/art.23... PMid:18576309.
16.
Ya J, Hu JZ, Nowacki AS, et al. Family history of psoriasis, psychological stressors, and tobacco use are associated with the development of tumor necrosis factor-α inhibitor-induced psoriasis: A case-control study. J Am Acad Dermatol. 2020;83(6):1599-605. https://doi.org/10.1016/j.jaad... PMid:32592879.
17.
Cabaleiro T, Prieto-Pérez R, Navarro R, et al. Paradoxical psoriasiform reactions to anti-TNFα drugs are associated with genetic polymorphisms in patients with psoriasis. Pharmacogenomics J. 2016;16(4):336-40. https://doi.org/10.1038/tpj.20... PMid:26194362.
18.
Boggs JME, Ramsay B, Lynch M. Paradoxical psoriasis caused by tumour necrosis factor inhibitor therapy. Clin Exp Dermatol. 2021;46(3):580-2. https://doi.org/10.1111/ced.14... PMid:33151572.
19.
Mazloom SE, Yan D, Hu JZ, et al. TNF-α inhibitor-induced psoriasis: A decade of experience at the Cleveland Clinic. J Am Acad Dermatol. 2020;83(6):1590-8. https://doi.org/10.1016/j.jaad... PMid:30576759.
20.
Conrad C, Di Domizio J, Mylonas A, et al. TNF blockade induces a dysregulated type I interferon response without autoimmunity in paradoxical psoriasis. Nat Commun. 2018;9(1):25. https://doi.org/10.1038/s41467... PMid:29295985 PMCid:PMC5750213.
21.
Fania L, Morelli M, Scarponi C, et al. Paradoxical psoriasis induced by TNF-α blockade shows immunological features typical of the early phase of psoriasis development. J Pathol Clin Res. 2019;6(1):55-68. https://doi.org/10.1002/cjp2.1... PMid:31577850 PMCid:PMC6966707.
22.
Tillack C, Ehmann LM, Friedrich M, et al. Anti-TNF antibody-induced psoriasiform skin lesions in patients with inflammatory bowel disease are characterised by interferon-γ-expressing Th1 cells and IL-17A/IL-22-expressing Th17 cells and respond to anti-IL-12/IL-23 antibody treatment. Gut. 2014;63(4):567-77. https://doi.org/10.1136/gutjnl... PMid:23468464.
23.
Sugaya M. The role of Th17-related cytokines in atopic dermatitis. Int J Mol Sci. 2020;21(4):1314. https://doi.org/10.3390/ijms21... PMid:32075269 PMCid:PMC7072946.
24.
Ren J, Deng L, Guo S, Liu H. Paradoxical reaction to IL-17A inhibitor: A case report and literature review. Front Med. 2024;11:1364127. https://doi.org/10.3389/fmed.2... PMid:38695018 PMCid:PMC11061499.
25.
Al-Janabi A, Eyre S, Foulkes AC, et al. Atopic polygenic risk score is associated with paradoxical eczema developing in patients with psoriasis treated with biologics. J Invest Dermatol. 2023;143(8):1470-78.e1. https://doi.org/10.1016/j.jid.... PMid:36804406.
26.
Dhingra N, Guttman-Yassky E. A possible role for IL-17A in establishing Th2 inflammation in murine models of atopic dermatitis. J Invest Dermatol. 2014;134(8):2071-4. https://doi.org/10.1038/jid.20... PMid:25029321 PMCid:PMC4101909.
27.
Puig L. Paradoxical reactions: Anti-tumor necrosis factor alpha agents, ustekinumab, secukinumab, Ixekizumab, and others. Curr Probl Dermatol. 2018;53:49-63. https://doi.org/10.1159/isbn.9... PMid:29131037.
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