The skin tissue is adversely affected by TNF-alpha blockers in patients with chronic inflammatory arthritis: a 5-year prospective analysis

Abstract

OBJECTIVE:We evaluated the incidence of and the main risk factors associated with cutaneous adverse events in patients with chronic inflammatory arthritis following anti-TNF-α therapy.METHODS:A total of 257 patients with active arthritis who were taking TNF-α blockers, including 158 patients with rheumatoid arthritis, 87 with ankylosing spondylitis and 12 with psoriatic arthritis, were enrolled in a 5-year prospective analysis. Patients with overlapping or other rheumatic diseases were excluded. Anthropometric, socioeconomic, demographic and clinical data were evaluated, including the Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index and Psoriasis Area Severity Index. Skin conditions were evaluated by two dermatology experts, and in doubtful cases, skin lesion biopsies were performed. Associations between adverse cutaneous events and clinical, demographic and epidemiological variables were determined using the chi-square test, and logistic regression analyses were performed to identify risk factors. The significance level was set at p<0.05.RESULTS:After 60 months of follow-up, 71 adverse events (73.85/1000 patient-years) were observed, of which allergic and immune-mediated phenomena were the most frequent events, followed by infectious conditions involving bacterial (47.1%), parasitic (23.5%), fungal (20.6%) and viral (8.8%) agents.CONCLUSION:The skin is significantly affected by adverse reactions resulting from the use of TNF-α blockers, and the main risk factors for cutaneous events were advanced age, female sex, a diagnosis of rheumatoid arthritis, disease activity and the use of infliximab.

Infliximab-induced skin manifestations in patients with inflammatory bowel disease

“…Patients with adverse skin events also had higher cumulative IFX infusion counts and longer disease and IFX therapy durations, although these findings were not statistically significant. In contrast to previous literature, although often reported in IBD and even rheumatoid [10,20] literature, female gender was not associated with skin manifestations. As the current hypotheses on the mechanisms of action for different anti-TNF-a-induced skin manifestations [4] offer no explanation for this finding, we suspect that reporting bias and the retrospective nature of some studies might strongly impact these findings.…”

“…[6,7] These skin lesions have also been described in prospective rheumatoid studies with incidence rates between 1.0 and 5.3% for psoriasiform and 18 and 26.5% for non-psoriasiform skin manifestations. [8][9][10] Although as the follow-up times, methods and study populations in all of the listed studies vary, results are not directly comparable. Smoking, increased BMI, short disease duration [11] and CD [5,12] have been suggested to associate specifically with psoriasiform lesions.…”

New‐onset vitiligo and progression of pre‐existing vitiligo during treatment with biological agents in chronic inflammatory diseases

“…More recently, biological therapies targeting the Th17/IL‐12/23 pathway have been developed and ustekinumab, an anti‐p40 IL‐12/23 product, is currently on the market for the treatment of psoriasis and psoriatic arthritis. All these different biological agents have been associated with various adverse events affecting the skin, with a frequency ranging from 10% to 60% . In a 5‐year prospective analysis of patients with chronic inflammatory arthritis, the main risk factors for cutaneous events under TNFα inhibitors were identified as advanced age, female sex, diagnosis of rheumatoid arthritis, disease activity and the use of infliximab .…”

“…All these different biological agents have been associated with various adverse events affecting the skin, with a frequency ranging from 10% to 60% . In a 5‐year prospective analysis of patients with chronic inflammatory arthritis, the main risk factors for cutaneous events under TNFα inhibitors were identified as advanced age, female sex, diagnosis of rheumatoid arthritis, disease activity and the use of infliximab . Psoriasis is among the most widely reported cutaneous side‐effect of anti‐TNFα therapy and is considered to occur as a paradoxical skin reaction …”

Dermatological side effects in rheumatological patients taking anti TNF-α treatment

“…Monitoring for DSE of the patients receiving TNF-α blocker treatment is important for early diagnosis and treatment. (2). TNF-α bloker tedavisi planlanan hastalarda, epidemiyolojik özellikler, çevresel ve genetik faktörler de göz önüne alınarak, özellikle enfeksiyöz ve immun advers deri hastalıkları riskinin farkında olunması ve hastaların bu yönden takibi önemlidir.…”