Abstract
Psoriasis is a chronic inflammatory disorder of the skin and joints. Although rarely life threatening, psoriasis can significantly impair quality of life (QOL) and cause considerable physical and psychological distress. Between 6 and 42% of patients with psoriasis develop psoriatic arthritis, which is characterized by stiffness, pain, swelling and tenderness of the joints. Nail psoriasis is highly prevalent in both plaque-type psoriasis and psoriatic arthritis and is found in approximately 50% of patients with psoriasis and in 80% of patients with psoriatic arthritis. Infliximab, a chimeric human-murine monoclonal antibody directed against tumour necrosis factor α, is approved in the USA and EU for the treatment of plaque psoriasis and psoriatic arthritis at a recommended dosage of 5 mg/kg administered by intravenous infusion at 0,2 and 6 weeks, then every 8 weeks thereafter. The EXPRESS and EXPRESS II trials demonstrated that infliximab is efficacious as induction and maintenance therapy in the treatment of moderate to severe plaque psoriasis and also improved health-related QOL. Infliximab is also efficacious in the treatment of psoriatic arthritis, as shown in the IMPACT and IMPACT II studies. Infliximab is generally well tolerated, with a similar adverse event profile in both psoriasis and psoriatic arthritis. The use of infliximab in three case reports is presented. The patients are similar to those normally seen by clinicians, and include a male patient with plaque psoriasis and a history of severe psoriatic arthritis who was corticosteroid dependent and in whom other systemic treatments were not effective or were not able to be used. This patient showed a rapid response to infliximab with no skin lesions or arthritis after 7 weeks’ treatment. Infliximab was also safe and effective in the treatment of a female patient with plaque and nail psoriasis and a history of psoriatic arthritis. Importantly, this case report supports the efficacy of infliximab in psoriatic nail disease in the context of severe skin and joint involvement. Case 3 describes a young male patient with moderate plaque-type psoriasis associated with severe nail involvement and early signs of psoriatic arthritis. Treatment with infliximab improved nail psoriasis and appears to be an effective biological treatment for nail psoriasis. Importantly, ultrasound was able to diagnose joint involvement, as seen from the proliferative synovitis in the distal interphalangeal joint and mild enthesitis, despite there being no clinical evidence of psoriatic arthritis. This case report highlights the importance of early screening. If such abnormalities are detected early on in the course of psoriasis, clinicians may be able to predict which patients are more likely to develop psoriatic arthritis, and therefore offer effective and long-term treatment that may reduce the disability and impairment of daily activities that can be associated with psoriatic arthritis.
Similar content being viewed by others
References
Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58(5): 826–50
Nevitt GJ, Hutchinson PE. Psoriasis in the community: prevalence, severity and patients’ beliefs and attitudes towards the disease. Br J Dermatol 1996; 135(4): 533–7
Augustin M, Kruger K, Radtke MA, et al. Disease severity, quality of life and health care in plaque-type psoriasis: a multicenter cross-sectional study in Germany. Dermatology 2008; 216(4): 366–72
Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 Suppl 2: ii14–17
Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008; 58(5): 851–64
Jiaravuthisan MM, Sasseville D, Vender RB, et al. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol 2007; 57(1): 1–27
Williamson L, Dalbeth N, Dockerty JL, et al. Extended report: nail disease in psoriatic arthritis-clinically important, potentially treatable and often overlooked. Rheumatology (Oxford) 2004; 43(6): 790–4
Lawry M. Biological therapy and nail psoriasis. Dermatol Ther 2007; 20(1): 60–7
Reich K, Ortonne JP, Kerkmann U, et al. Skin and nail responses after 1 year of infliximab therapy in patients with moderate-to-severe psoriasis: a retrospective analysis of the EXPRESS Trial. Dermatology 2010; 221(2): 172–8
Augustin M, Reich K, Blome C, et al. Nail psoriasis in Germany: epidemiology and burden of disease. Br J Dermatol 2010; 163(3): 580–5
Baran R. The burden of nail psoriasis: an introduction. Dermatology 2010; 221 Suppl 1:1–5
Langley RG, Dauden E. Treatment and management of psoriasis with nail involvement: a focus on biologic therapy. Dermatology 2010; 221 Suppl 1: 29–42
Papoutsaki M, Costanzo A. Diagnosis and treatment of psoriasis and psoriatic arthritis. BioDrugs 2012; Citation to be confirmed at publication
Centocor Ortho Biotech Inc. Remicade(RM) (infliximab) for IV injection. [Online] 2009; Available from: http://www.remicade.com/remicade/assets/ HCP_PPI.pdf
Electronic Medicines Compendium. Remicade 100mg powder for concentrate for solution for infusion. Summary of Product Characteristics. Schering- Plough Ltd. [Online] 2010; Available from: http://www.medicines.org.uk/emc/document.aspx?documentId=3236
Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet 2005; 366 (9494): 1367–74
Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol 2007; 56(1): 31e1–15
Gottlieb AB, Evans R, Li S, et al. Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo- controlled trial. J Am Acad Dermatol 2004; 51(4): 534–42
Reich K, Nestle FO, Papp K, et al. Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial. Br J Dermatol 2006; 154(6): 1161–8
Feldman SR, Gottlieb AB, Bala M, et al. Infliximab improves health-related quality of life in the presence of comorbidities among patients with moderate- to-severe psoriasis. Br J Dermatol 2008; 159(3): 704–10
Antoni CE, Kavanaugh A, Kirkham B, et al. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum 2005; 52(4): 1227–36
Antoni C, Krueger GG, de Vlam K, et al. Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial. Ann Rheum Dis 2005; 64(8): 1150–7
Antoni CE, Kavanaugh A, van der Heijde D, et al. Two-year efficacy and safety of infliximab treatment in patients with active psoriatic arthritis: findings of the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). J Rheumatol 2008; 35(5): 869–76
Kavanaugh A, Krueger GG, Beutler A, et al. Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the IMPACT 2 trial. Ann Rheum Dis 2007; 66(4): 498–505
Woolacott N, Bravo Vergel Y, Hawkins N, et al. Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation. Health Technol Assess 2006; 10(31): iii–iv, xiii-xvi, 1-239
Tan AL, Rhodes LA, Marzo-Ortega H, et al. What imaging has told us about psoriatic arthritis. Rheumatology in Practice 2008; 5(4): 14–16
De Filippis LG, Caliri A, Lo Gullo R, et al. Ultrasonography in the early diagnosis of psoriasis-associated enthesopathy. Int J Tissue React 2005; 27(4): 159–62
Rich P, Scher RK. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol 2003; 49(2): 206–12
Noiles K, Vender R. Nail psoriasis and biologics. J Cutan Med Surg 2009; 13(1): 1–5
Reich K. Approach to managing patients with nail psoriasis. J Eur Acad Dermatol Venereol 2009; 23 Suppl 1: 15–21
Bianchi L, Bergamin A, de Felice C, et al. Remission and time of resolution of nail psoriasis during infliximab therapy. J Am Acad Dermatol 2005; 52(4): 736–7
Ash Z, Gaujoux-Viala C, Gossec L, et al. A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis 2011; DOI: 10.1136/ard.2011.150995
Adisen E, Aral A, Aybay C, et al. Anti-infliximab antibody status and its relation to clinical response in psoriatic patients: A pilot study. J Dermatol 2010; 37(8): 708–13
Roux CH, Brocq O, Breuil V, et al. Pregnancy in rheumatology patients exposed to anti-tumour necrosis factor (TNF)-alpha therapy. Rheumatology (Oxford) 2007; 46(4): 695–8
Puig L, Barco D, Alomar A. Treatment of psoriasis with anti-TNF drugs during pregnancy: case report and review of the literature. Dermatology 2010; 220(1): 71–6
Cohen AD, Sherf M, Vidavsky L, et al. Association between psoriasis and the metabolic syndrome. A cross-sectional study. Dermatology 2008; 216(2): 152–5
Saraceno R, Schipani C, Mazzotta A, et al. Effect of anti-tumor necrosis factor-alpha therapies on body mass index in patients with psoriasis. Pharmacol Res 2008; 57(4): 290–5
Briot K, Gossec L, Kolta S, et al. Prospective assessment of body weight, body composition, and bone density changes in patients with spondyloarthropathy receiving anti-tumor necrosis factor-alpha treatment. J Rheumatol 2008; 35(5): 855–61
McGonagle D, Tan AL, Benjamin M. The nail as a musculoskeletal append- age-implications for an improved understanding of the link between psoriasis and arthritis. Dermatology 2009; 218(2): 97–102
Tan AL, Benjamin M, Toumi H, et al. The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis-a high-resolution MRI and histological study. Rheumatology (Ox- ford) 2007; 46(2): 253–6
Wortsman X, Jemec GB. Ultrasound imaging of nails. Dermatol Clin 2006; 24(3): 323–8
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Papoutsaki, M., Osório, F., Morais, P. et al. Infliximab in Psoriasis and Psoriatic Arthritis. BioDrugs 27 (Suppl 1), 13–23 (2013). https://doi.org/10.1007/BF03325638
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03325638