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Abstract
Psoriatic arthritis remains a common cause of morbidity in patients with psoriasis. Little is known about the natural history of the disease and dermatologists do not consistently screen for its presence. We describe a patient with severe psoriasis where long-term biologic therapy with a tumour necrosis factor inhibitor was interrupted for clinical reasons, leading to a rapidly evolving axial spondyloarthritis and oligoarthritis. This unusual presentation of psoriatic arthritis may reflect masking of the disease by long-term treatment with a tumour necrosis factor inhibitor. We advocate the use of screening for psoriatic arthritis, including before and during treatment with biologic therapies.
Acknowledgements
AF is a North-West England MRC Clinical Research Training Fellow in Clinical Pharmacology and Therapeutics. CEMG is supported in part by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre. RBW and HC are NIHR Senior Clinical Lecturers.
Declaration of interest:
All authors work in the UK National Health Service (NHS). CEMG has acted as a consultant and/or speaker for Abbott, Centocor, Incyte, Janssen-Cilag, Leo Pharma, Novartis, Pfizer and Schering-Plough, all of which manufacture therapies used in the treatment of psoriasis. HC has acted as a consultant and/or speaker for Janssen Cilag, Pfizer and Abbott, all of which manufacture therapies used in the treatment of psoriasis and PsA. RBW has acted as a consultant and/or speaker for Abbott, Janssen Cilag, Leo Pharma, Pfizer and Schering-Plough, all of which manufacture therapies used in the treatment of psoriasis. AF has received educational support to attend conferences from Pfizer, Abbott and Leo Pharma, all of which manufacture therapies used in the treatment of psoriasis.