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Journal of the American Academy of Dermatology
Volume 72, n° 2
pages 253-260 (février 2015)
Doi : 10.1016/j.jaad.2014.10.038
accepted : 28 October 2014
Original Articles

Treatment of coexistent psoriasis and lupus erythematosus
 

Sowmya Varada, BS a, b, Alice B. Gottlieb, MD, PhD a, d, Joseph F. Merola, MD, MMSc c, Ami R. Saraiya, MD a, Suzanne J. Tintle, MD, MPH a,
a Department of Dermatology, Tufts University Medical Center, Boston, Massachusetts 
d Tufts University School of Medicine, Boston, Massachusetts 
b Jefferson Medical College, Philadelphia, Pennsylvania 
c Department of Dermatology and Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 

Reprint requests: Suzanne J. Tintle, MD, MPH, Tufts University Medical Center, Department of Dermatology, 260 Tremont Street, 14th floor, Boston, MA 02111.
Abstract
Background

The coexistence of psoriasis and lupus erythematosus (LE) is rare. Anecdotal evidence suggests that anti–tumor necrosis factor alfa (TNF-α) agents may be efficacious in LE, although their use is commonly avoided in this disease because of concern for lupus flare.

Objective

We sought to describe the epidemiology, serologic findings, and therapeutic choices in patients with coexistent psoriasis/psoriatic arthritis and LE and to determine the risk of lupus flares with TNF-α inhibitors.

Methods

We performed a retrospective multicenter study of patients given the diagnoses of psoriasis (or psoriatic arthritis) and lupus erythematosus (systemic LE or cutaneous LE, including either subacute cutaneous LE or discoid LE) at 2 academic tertiary-care centers.

Results

A total of 96 patients with a mean age of 56 years was included. We report higher-than-expected rates of white race and psoriatic arthritis. One clinical lupus flare was observed in a patient receiving a TNF-α inhibitor, resulting in an incidence of 0.92% lupus flares per patient-year of TNF-α inhibitor use.

Limitations

Retrospective chart review, small sample size, and limited documentation.

Conclusion

Anti–TNF-α agents, ustekinumab, and abatacept may be valid treatment options for patients with concomitant LE and psoriasis. Clinical lupus flares in LE patients treated with TNF-α inhibitors were infrequent.

The full text of this article is available in PDF format.

Key words : psoriasis, lupus erythematosus, tumor necrosis factor alfa

Abbreviations used : ANA, dsDNA, DLE, LE, Ps, PsA, SCLE, SLE, TNF-α



 Funding sources: None.
 Conflicts of interest: None declared.



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