Clinical Characteristics And Management Of Psoriasis Induced Or Aggravated By TNF-alpha Antagonists

OBJECTIVE:To investigate the clinical features,possible causes,treatment and prognosis of stimulating or aggravating psoriasis during the treatment of autoimmune diseases with TNF-a antagonists.METHODS:The Chinese and English databases of Medline,Springerlink,Scicnedirect,Wiely,Web of Science,CNKI,Wanfang data and CBM were retrospectively searched for the case data of patients with psoriasis induced or aggravated by TNF-alpha antagonist therapy published in domestic and foreign literature(mainly in the form of case reports,the rest in the works).RESULTS:A total of 78 patients(33 rheumatoid arthritis,18 Crohn’s disease,9 psoriatic arthritis,9 ankylosing spondylitis,ABD,and juvenile idiopathic arthritis)were included in 27 articles.For example,1 case of seronegative spondyloarthropathy,1 case of ulcerative colitis,1 case of seronegative spondyloarthropathy with Crohn’s disease,1 case of Behcet’s disease,and 1 case of SAPHO syndrome,the clinical features include:(1)more common in women;mainly in middle-aged and older;(2)clinically used TNF-a antagonists etanercept,infliximab and adalimumab can induce psoriatic rash;(3)The duration of adverse reactions varies from a minimum of 4 days to a maximum of 72 months;however,most patients develop a psoriasis rash during the first year of treatment.(4)The main types of new psoriasis are pustular psoriasis,of which palmoplantar pustulosis is the most common,followed by vulgar psoriasis;(5)Most of the patients with psoriasis induced by TNF-alpha antagonist have no serious clinical symptoms.Stopping or changing monoclonal antibodies,combined with local treatment,can alleviate the disease.A few patients with severe psoriasis need to stop taking drugs and systemic treatment;(6)The clinical features of most patients with skin lesions are consistent with histopathological features;(7)A small number of patients have a history of personal and family psoriasis;(8)A small number of patients have a history of smoking.CONCLUSION:With the increasing application of TNF-alpha antagonists in autoimmune diseases such as rheumatoid arthritis,ankylosing spondylitis,inflammatory bowel disease,psoriasis and psoriatic arthritis,the adverse reactions in the application process are gradually recognized.One of the contradictory adverse reactions is to induce or aggravate the original psoriasis.The mechanism of this adverse reaction is still unclear.Several hypothetical theories have been proposed,including the theory of interferon imbalance,the role of key cytokines,genetic factors,smoking history and so on.For the patients with this adverse reaction,the light can be treated by external hormones,and the large area of skin lesions need systemic treatment.However,some patients need to stop TNF-alpha antagonist therapy because of the progress of skin rash.When TNF-alpha antagonists are used clinically,we should not only pay attention to their therapeutic effects,but also closely observe the possible adverse reactions in the course of drug use,especially the adverse reactions which are difficult to distinguish and easy to ignore.The best treatment strategy should be selected according to the specific conditions of patients in order to better apply biological agents.