Sacroiliitis in a psoriasis patient after switching from etanercept to ustekinumab

Recently ustekinumab has been approved for the therapy of psoriatic arthritis (PsA). Some case series have been published reporting new onset of inflammatory arthritis in psoriasis patients treated with ustekinumab. In addition, flare of joint inflammation in PsA patients has also been reported. We describe a case series of seven patients affected by PsA who experienced either a worsening or a flare of inflammatory arthritis during treatment with ustekinumab.

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“…Our data support previously reported observations indicating that blockade of IL12/IL23 is not sufficient to control psoriatic joint disease .…”

Section: Introductionsupporting

confidence: 92%

“…From 2011, an increasing number of new onset or flare of PsA in patients taking ustekinumab has been reported .…”

Section: Discussionmentioning

confidence: 99%

How effective is ustekinumab in controlling psoriatic arthritis?

Bonifati

Graceffa

2015

Dermatologic Therapy

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“…These events were classified as “paradoxical psoriatic arthritis (PPsA).” The age of these patients was 49.7 ± 13.5 years, ranging from 18 years to 85 years, and the male to female ratio was 1.21:1 (51M:42F). More than half (48/94, 51.1%) of these events involved ustekinumab treatment [ 57 , 60 , 62 , 63 , 65 – 67 , 72 , 74 , 75 , 77 , 78 ], and tumor necrosis factor (TNF)-inhibitors accounted for another 39.4% (37/94) [ 56 , 58 , 61 , 65 , 66 , 68 , 70 , 72 , 79 , 80 ]. The remaining 10% belong to five novel biologics that target the Th17/IL-23 pathway [ 64 , 71 – 73 , 76 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 48 patients who were reported PPsA after ustekinumab, 30 patients (62.5%) had new-onset arthralgia [ 57 , 60 , 62 , 65 – 67 , 72 , 75 , 78 ], while the other 18 patients (37.5%) had exacerbation of preexisting arthritis [ 57 , 62 , 63 , 67 , 74 , 77 ]. Most of the patients had peripheral arthritis (34/39, 87.2%) [ 57 , 60 , 62 , 63 , 66 , 67 , 74 , 75 , 77 ], followed by dactylitis (8/39, 20.5%) [ 60 , 62 , 63 , 75 ], enthesitis (8/39, 20.5%) [ 62 , 63 , 75 ], and spondylitis (5/39, 12.8%) [ 63 , 66 , 75 , 78 ]. The mean latency for the 44 cases that reported the exact time to arthritis onset was 11.42 ± 11.45 months (range 3 days to 4 years).…”

Section: Resultsmentioning

confidence: 99%

“…The mean latency for the 44 cases that reported the exact time to arthritis onset was 11.42 ± 11.45 months (range 3 days to 4 years). We divided the patients into three groups: 18 patients experiencing PsA exacerbation [ 57 , 62 , 63 , 67 , 74 , 77 ], 13 bio-naïve patients with psoriasis [ 60 , 62 , 65 , 67 , 75 ], and 17 patients pretreated with TNF-inhibitors [ 57 , 62 , 65 , 66 , 72 , 75 , 78 ]. After grouping, mean latency was 7.42 ± 8.93 months in the PsA exacerbation group, 18.2 ± 14.4 months in the bio-naïve group, and 10.2 ± 8.59 months in the TNF-inhibitors pretreated group.…”

Section: Resultsmentioning

confidence: 99%

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Drug- or Vaccine-Induced/Aggravated Psoriatic Arthritis: A Systematic Review

Yeh,

Tsai

2024

Dermatol Ther (Heidelb)

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Introduction Drugs and vaccines have been less studied as inducing or aggravating factors for psoriatic arthritis (PsA) compared with psoriasis. Thus, the present study collected and summarized the publications to date about this issue. Methods We conducted a systematic literature search through the PubMed, Embase, and Cochrane databases to identify all reports on potential drug- and vaccine-related PsA events until 28 February 2023. Results In total, 179 cases from 79 studies were eligible for study. Drugs commonly reported include coronavirus disease 2019 (COVID-19) mRNA vaccines (6 cases), bacillus Calmette–Guerin (BCG) vaccine (3 cases), interferon (18 cases), immune-checkpoint inhibitors (ICI) (19 cases), and biologic disease-modifying antirheumatic drugs (bDMARDs) (127 cases). Drugs causing psoriasis may also induce or aggravate PsA (6 cases). BDMARD-related PsA mostly occurred in a “paradoxical” setting, in which the bDMARDs approved for the treatment of psoriasis induce or aggravate PsA. The reported latency may be delayed up to 2 years. Peripheral arthritis (82.3%) was the most common manifestation of drug- and vaccine-related PsA, followed by dactylitis (29.1%), enthesitis (23.4%), and spondyloarthritis (17.7%). Conclusions Drugs and vaccines may be implicated in the aggravation of PsA. Possible mechanisms include cytokine imbalance, immune dysregulation, or inadequate PsA treatment response compared with psoriasis. Most reports are case based without controls, so more studies are needed to further prove the causality. However, early recognition of factors causing or aggravating PsA is important to prevent the irreversible joint damage. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-023-01082-z.

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Ustekinumab

2015

Reactions Weekly

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Sacroiliitis in a psoriasis patient after switching from etanercept to ustekinumab

Cited by 3 publications

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How effective is ustekinumab in controlling psoriatic arthritis?

How effective is ustekinumab in controlling psoriatic arthritis?

Drug- or Vaccine-Induced/Aggravated Psoriatic Arthritis: A Systematic Review

Ustekinumab

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