Occurrence of psoriasis while on TNFα antagonists is a paradoxical effect of agents that treat psoriasis, and is described in larger cohorts of inflammatory bowel disease (IBD), pediatric IBD, and rheumatoid arthritis. However, there is a paucity of data available in JIA. The objective of this study is to determine the prevalence of anti-TNFα-induced psoriasis in JIA patients in one pediatric rheumatology center, and to characterize these patients with an analysis of their treatment course. 

Methods:

A retrospective chart review was performed on current pediatric rheumatology patients with JIA on anti-TNFα agents (including infliximab, etanercept, and adalimumab), who developed TNFα inhibitor-induced psoriasis at our center. Information such as patient demographics, personal/family history of psoriasis, specific biologic agent(s), drug class change, discontinuation of agent, time until psoriasis onset from initiation of biologic therapy, concomitant therapies, and response to therapy were collected on affected patients. The prevalence of TNFα inhibitor-induced psoriasis was calculated in JIA patients on TNFα inhibition and in pediatric rheumatology patients on TNFα inhibition who do not have JIA.

Results:

Six of 100 (6%) JIA patients on anti-TNFα therapy at our institution were diagnosed with TNFα inhibitor-induced psoriasis. Pediatric rheumatology patients on anti-TNFα therapy for non-JIA indications such as uveitis, psoriasis, and inflammatory bowel disease (IBD) (n=15) did not experience psoriasis aside from 1 patient (6.7%). Therefore, the prevalence for all pediatric rheumatology patients on TNFα inhibition in our center is 6% (7/115). Of the JIA cases with anti-TNFα-induced psoriasis, all were female, with a median age of 14 (range 2-18) yrs. Affected patients did not have a family or personal history of psoriasis. Time from initiation of anti-TNFα agents to onset to psoriasis was a median of 16.5 (range 10 to 35) mos. 100% of patients with TNFα inhibitor-induced psoriasis experienced plaque psoriasis in two or more locations, including four with moderate to severe scalp involvement. Two patients achieved complete response following class switch while one patient had significant improvement following discontinuation of anti-TNFα therapy. Two patients who switched to different TNFα antagonists had no improvement in psoriasis, while two patients who continued their current anti-TNFα agents both had partial improvement with topical therapies.

Conclusion:

Our findings demonstrate the prevalence of anti-TNFα-induced psoriasis in JIA in a single center. In terms of response to therapy in JIA patients, a complete response (50%) occurred in those who underwent a class switch or discontinued TNFα inhibition.