During recent years, much has been learnt about the immunopathology of psoriasis and psoriatic arthritis (PsA). There has been increasing evidence that proinflammatory cytokines, in particular tumour necrosis factor α (TNFα), may play a central part in potentiating the inflammatory process. Both CD4+ and CD8+ T cells are found in psoriatic lesions.¹ Thus most of the treatments for psoriasis and PsA are immunosuppressive.² However, there are several patients refractory to treatment in whom blockade of TNFα by anti-TNFα inhibitors may be useful.³

Five patients (three male, two female; mean (SD) age 41.0 (3.3) years) with longstanding disease (7.9 (3.7) years) refractory to immunosuppressive drugs and corticosteroids were studied. Although some clinical improvement was seen in their musculoskeletal complaints, psoriasis was poorly controlled, requiring frequent inpatient admissions to hospital.

Patients were treated with intravenous infliximab (5 mg/kg, …