Palmoplantar pustulosis with psoriatic arthritis ineffective to interleukin-17 inhibitors: two patients successfully treated with upadacitinib

Abstract

Palmoplantar pustulosis (PPP) is a rare chronic pustular disease. Psoriatic arthritis (PsA) is one of the common manifestations of arthritis in PPP associated with a high burden of disease. The treatment of PPP is difficult and still in the exploratory stage. Only a few cases show that PPP complicated with arthritis have been successfully treated with janus kinase inhibition, interleukin (IL)-6 inhibitors, IL-12/23 inhibitors and tumor necrosis factor inhibitors. Here we reported that two patients were diagnosed as PPP with PsA and initially treated with IL-17 inhibitors. One case was only partially relieved, and the other case had severe paradoxical reaction in the trunk. The joint and skin condition of two patients had been significantly improved without reported adverse reactions after 18 weeks treatment with upadacitinib, which support upadacitinib may be a potential option for patients with PPP combined PsA.

Keywords:

• Palmoplantar pustulosis
• psoriatic arthritis
• upadacitinib
• interleukin-17 inhibitors

Acknowledgements

We thank the patients for their participation in this study.

Ethical approval

The patients in this manuscript has given written informed consent to publication of their case details.

Author contributions

ZYO-Z collected samples and write the paper. WY-M draft the figures and charts. YY-W analyzed the data and revised this manuscript. W-L performed clinical evaluation, sample collection, treatment and planned experimental design. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work including the Rapid Service Fee was supported in part by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University [Grant ZYJC21050] and the Key R&D project of Science and Technology Department of Sichuan Province [Grant 2021YFG0306].