Background/Purpose:

The development of psoriasis while on TNFi is a paradoxical effect of agents that treat psoriasis and is described in larger cohorts inflammatory bowel disease (IBD) and rheumatoid arthritis. However, there is a paucity of data available on this entity in JIA. The objectives of this study were to determine the prevalence of TNFi-induced psoriasis in patients with JIA at two pediatric centers, and psoriasis response to therapy modifications.

Methods:

A retrospective chart review at two pediatric institutions was performed on patients with JIA treated with TNFi (adalimumab, etanercept, infliximab) who developed psoriasis. TNFi-induced psoriasis was defined as any incident diagnosis of psoriasis after starting a TNFi. Patients with a personal history of psoriasis prior to TNFi therapy were excluded. Following diagnosis, improvement or worsening of psoriasis with medication changes were defined based on physician assessments.

Results:

Twelve of 169 (7.1%) patients on TNFi for JIA were diagnosed with TNFi-induced psoriasis, including 7.9% and 6.4% at Children’s Hospital of Philadelphia and Goryeb Children’s Hospital respectively. All 12 cases were female, taken from a mostly female cohort (64%). The median age was 12 (range 2-18) yrs. One patient had a family history of psoriasis. Time from initiation of TNFi agents to onset of psoriasis was a median of 19 (range 7 to 40) mos. All affected patients experienced plaque psoriasis including seven (58%) with moderate to severe scalp involvement. Three (25%) patients achieved significant improvement or complete resolution of rash after switching to a different class of biologic agents while 3 (25%) patients had significant improvement or complete resolution following discontinuation of biologic therapy (and no concomitant changes to other systemic therapy). One of 5 patients who switched to a different TNFi had significant improvement, while 4 had worsening symptoms or partial improvement.

Conclusion:

Our findings demonstrate the prevalence of TNFi-induced psoriasis in JIA at two centers. Based on these findings, additional larger cohort studies that adjust for confounding by indication are needed to assess psoriasis response to different treatments.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tumor-necrosis-factor-%ce%b1-inhibitor-tnfi-induced-psoriasis-prevalence-and-response-to-therapy-in-patients-with-juvenile-idiopathic-arthritis-jia-in-two-childrens-hospitals/