Ustekinumab
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Ustekinumab Paradoxical psoriatic arthritis in the form of spondylodiscitis and sacroiliitis: 2 case reports
In a case report, a 37-year-old man and a 28-year-old woman developed paradoxical psoriatic arthritis in the form of spondylodiscitis and sacroiliitis, respectively during treatment with ustekinumab for plaque psoriasis. Case 1: The 37-year-old man had generalised plaque psoriasis, which did not respond to acitretin, unspecified topical steroids and phototherapy. Two weeks following first injection of SC ustekinumab 45mg, he reported severe acute lower back pain which lasted for 1 week. After 4 weeks, he received second dose of ustekinumab 45mg. After 2 weeks, he experienced an identical recurrence of arthritis. A spine MRI demonstrated L2–L3 spondylodisicitis. He had no previous psoriatic arthritis. A paradoxical psoriatic arthritis in the form of spondylodiscitis was confirmed. Therefore, he was treated with off-label pentoxifylline 400mg three times daily, which resolved the pain in few days. He received pentoxifylline for 10 days following ustekinumab without any recurrence of arthritis for 15 months. Case 2: The 28-year-old woman had extensive plaque psoriasis, which did not respond acitretin, unspecified topical steroids and narrowband ultraviolet-B therapy. Sixteen days following the first and second injections of ustekinumab 45mg, she reported severe lower back and bilateral hip pain which lasted for 2 weeks. MRI showed bilateral sacroiliitis. A paradoxical psoriatic arthritis in the form of sacroiliitis was confirmed. Therefore, she was treated with off-label pentoxifylline 400mg three times daily for 10 days following each injection. No similar arthritic episode was observed for 19 months. Skayem C, et al. First cases of ustekinumab-induced spondylodiscitis and sacroiliitis in patients with psoriasis successfully treated with pentoxyfilline. Dermatologic Therapy 803505099 33: No. 4, Jul-Aug 2020. Available from: URL: http://doi.org/10.1111/dth.13728
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Reactions 3 Oct 2020 No. 1824
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