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

Figures & data

Table 1. Characteristics of two patients with Palmoplantar pustulosis (PPP).

	Patient 1	Patient 2
Age at onset (years)	47	54
Sex	Female	Female
BMI	19.60	21.05
Occupational Exposure	No	No
Potential causative factors
Focal infection	No	No
Smoking habit	Second-hand smoking	Current
Clinical presentation
Disease duration at diagnosis (months)	5	12
Follow-up after diagnosis (months)	7	8
Location of PPP (first)	Palms	Palms and sole
Nail involvement	Yes	No
Joint involvement	Yes	Yes
Location of pain
Peripheral joints	Finger joint	No
Axial joint	Lumbar spine	Lumbar and sacroiliac joint
Family history	No	Yes*
Personal history	Thyroid nodule	Hyperthyroidism
Comorbid disease	Anxiety	Anxiety
Treatment
Topical corticosteroids	NA	NR
Secukinumab	NA	PR
Ixekizumab	PR	NA
Upadacitinib	CR	CR

* The father of patient 2 had psoriasis. BMI, body mass index (calculated as weight in kilograms divided by height in meters squared). CR: complete response; NA: not available; NR: no response; PR: partial response.

Figure 1. Clinical features of the two patients. (A) Palm of patient 1 before using upadacitinib. (B) Sole of patient 1 before using upadacitinib. (C) Palm of patient 2 before using upadacitinib. (D) The sole of patient 2 before using upadacitinib. (E) Palm of patient 1 after using upadacitinib for 20 weeks. (F) Sole of patient 1 after using upadacitinib for 20 weeks. (G) Palm of patient 2 after using upadacitinib for 18 weeks. (H) Sole of patient 2 after using upadacitinib for 18 weeks.

Table 2. The palmoplantar and joint conditions of the two patients.

	Patient 1		Patient 2
	Before*	After^#	Before*	After^#
The palmoplantar conditions
PPPASI score	14.1	0.8	21.9	0.6
DLQI score	28	10	11	5
Itching VAS score	2	0	4	0
Pain VAS score	2	0	7	0
The joint conditions
Number of tender joints	2	0	2	0
Number of swollen joints	2	0	0	0
BASFI	7.5	0.2	0	0
BASDAI	1.55	0	1	0
VAS score of back pain	7	1	0	0
HAQ	1.35	0.1	0	0

* The palmoplantar and joint conditions before using upadacitinib; ^#The palmoplantar and joint condition after 20 weeks of treatment with upadacitinib. PPPASI: palmoplantar pustulosis area and severity index; DLQI: Dermatology life quality index; VAS: Visual analogue scale; BASFI: Bath ankylosing spondylitis functional index; BASDAI: Bath ankylosing spondylitis disease activity index; HAQ: Health assessment questionnaire.