Background Biological therapy (BT) has been a major advance in the treatment of inflammatory arthritis; however, they have also been associated with many side effects. Recently, a broad spectrum of skin lesions induced by these agents (SLIBT) has been described.
Objectives Objective: To describe the prevalence and characteristics of SLIBT observed in our inflammatory arthritis patients. A secondary objective was to analyse if there were any differences between patients with rheumatoid arthritis (RA) or those with a spondyloarthritis (SPA).
Methods Methods: A cross-sectional study was conducted from April 2006 to September 2012. All patients received at least one dose of BT. The main study variable was the presence of SLIBT. We collected sociodemographic data, aspects related to the underlying disease, type of cutaneous lesions, response to different therapeutic strategies, number of BT previous to lesion or time from beginning of BT responsible of the adverse event.
Results Results: A total of 214 patients with 351 treatments were recruited. 57% were women with a mean age at onset of BT of 42.40 years (5-78). The diagnoses of underlying diseases were: RA 45.8%, SPA 51.9% and 2.3% JIA. We detected 88 SLIBT in 63 patients. The prevalence of SLIBT in our patients was 29.4%. The 25.07% of the treatments of our study induced cutaneous side effects. 61.4% of SLIBT were presented at the first drug used. Lesions were classified into the following groups1: skin lesions associated with treatment (SLAT) 41 (46.6%), infections 20 (5.7%), immune-mediated 26 (29.6%) and a one benign melanocytic nevi. We did not detect any neoplasm. In our study, the most frequent infections were viral versus bacterial or fungal. The prevalence of herpes zoster was 2.3%. 14 (6.5%) patients had a paradoxical psoriasis (PSP). The presence of SLIBT was more common in RA (18.8%) than in the SPAs (11.48%) and it was statistically significant (p = 0.047). SLATs were more frequently detected in RA (18.18%) than in SPA (11.48%). Finally, when we analyse each manifestation individually we only found significant differences in herpes zoster (p = 0.02) and generalized pruritus (p = 0.02) in the group of RA. Immune-mediated lesions were more often observed in RA patients but the differences was not statistically significant.
Conclusions Conclusions: SLIBT are common side effects observed in patients under BT. They have a broad clinical spectrum. In general, SLIBT are more frequent in RA than in the SPA, especially shingles and likely, immune-mediated manifestations.
Hernández, M. V., Meineri, M., Sanmartí, R. Skin lesions and treatment with tumour necrosis factor alpha antagonists. Reumatol Clin. 2012; Jul 3, Epub ahead of print.
Disclosure of Interest None Declared