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We read with interest the debate about liver toxicity of infliximab in psoriatic arthritis (PsA).1,2 We describe the case of a 53 year old woman with a 4 year history of refractory PsA who developed transaminasitis during infliximab treatment.
CASE REPORT
Despite combination treatment (ciclosporin 300 mg/day, fluocortolone 10 mg/day, and methotrexate (MTX)15 mg/week intramuscularly), disease activity was still high, and intravenous infliximab at 3 mg/kg was administered initially at weeks 0, 2, 6, 14 and then every 6 weeks. Ciclosporin was withdrawn.
Within 3 weeks she improved, fluocortolone was gradually stopped while methotrexate (MTX) 20 mg/week intramuscularly, was continued. After the sixth infusion, she developed a mild transaminasitis and MTX, initially tapered, was stopped. After the eighth infusion transaminases continued to rise and in the absence of any other plausible cause, infliximab was withdrawn.
She was admitted to our department with persistently high values of aspartate aminotransferase and alanine aminotransferase and a flare of PsA. …