抗肿瘤坏死因子治疗关节病中出现银屑病加重或新发二例并文献复习

New onset or exacerbation of psoriatic skin lesions in patients with arthritides treated with tumor necrosis factor alpha antagonists

目的探讨抗肿瘤坏死因子（TNF）治疗关节病的疗效以及加重或新发银屑病的原因。方法分析2例使用TNF治疗过程中出现银屑病加重和新发银屑病的关节病[1例为银屑病关节炎（PsA），1例为强直性脊柱炎（AS）]的临床特点，并复习有关文献。结果1例PsA患者在使用抗TNF过程中出现银屑病皮损加重，停药后缓解，加用后再次出现皮损加重；1例确诊的AS使用抗TNF过程中出现新发银屑病，停药后皮损消失，再次使用后皮损再次出现。结论抗TNF是治疗脊柱关节病（SpA）等关节病的有效药物，但在治疗过程中可能出现银屑病皮损，停药后可以减轻，具体机制尚不清楚。

Objective To investigate the efficacy of tumor necrosis factor alpha （TNF-α） antagonists therapy and the possible causes of new onset or exacerbation of psoriatic skin lesion in patients with arthritides treated with TNF-α antagonists therapy. Methods One patient with definite psoriatic arthritis and one patient with definite ankylosing spondylitis, who were treated with TNF-α antagonist therapy developed an unexpected exacerbation or new onset of psoriatic skin lesion, were investigated in this study. Furthermore, the literatures associated with psoriasis induced by anti-TNF-α therapy were reviewed. Results The patient with psoriatic arthritis experienced exacerbation of psoriatic skin lesion and the skin lesions subsided after discontinuation of etanercept therapy. The skin lesions recun＇ed with re-introduction of etaoereept, which improved after withdrawal of etanereept therapy. The patient with ankylosing spondylitis unexpectedly developed psoriasis vulgaris after receiving etanercept therapy. The skin lesion waxed and waned followed the administration or discontinuation of etanercept therapy. The same settings were reported in patients with rheumatoid arthritis receiving different types of anti-TNF-α therapy. Conclusion Blockage of TNF-α is highly effective in arthritides. However, some patients with arthritides can unexpectedly develop either a new onset or exacerbation of psoriatic skin lesions after initiation of TNF-α antagonist therapy. The skin lesions subside after discontinuation of the TNF-α antagonist therapy, but the causes remain unclear.