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Dig Dis Sci. 2018 Sep;63(9):2430-2438. doi: 10.1007/s10620-018-5096-2. Epub 2018 May 8.

Stricturing and Fistulizing Crohn's Disease Is Associated with Anti-tumor Necrosis Factor-Induced Psoriasis in Patients with Inflammatory Bowel Disease.

Author information

1
Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital IBD Centre, University of Toronto, 437-600 University Avenue, Toronto, ON, M5G 1X5, Canada. adam.weizman@sinaihealthsystem.ca.
2
Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital IBD Centre, University of Toronto, 437-600 University Avenue, Toronto, ON, M5G 1X5, Canada.
3
Department of Public Health Sciences, University of Toronto, 610 University Avenue, Suite 10-512, Toronto, ON, M5G 2M9, Canada.
4
Division of Dermatology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-724, Toronto, ON, M4N 3M5, Canada.
5
Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital IBD Centre, University of Toronto, 411-600 University Avenue, Toronto, ON, M5G 1X5, Canada.
6
Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital IBD Centre, University of Toronto, 445-600 University Avenue, Toronto, ON, M5G 1X5, Canada.
7
Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital IBD Centre, University of Toronto, 441-600 University Avenue, Toronto, ON, M5G 1X5, Canada.

Abstract

BACKGROUND:

Paradoxical development of psoriasis in patients on anti-TNF agents has been increasingly reported.

AIM:

The aim was to characterize the prevalence and clinical characteristics of anti-TNF-associated psoriasis in a large cohort of inflammatory bowel disease patients.

METHODS:

Medical records of patients with Crohn's disease or ulcerative colitis treated with anti-TNF therapy at a single, tertiary IBD center were identified between 2004 and 2016. Patients identified as having developed psoriasis while on anti-TNF underwent detailed retrospective review of dermatologic features and changes in IBD treatment prompted by the development of psoriasis.

RESULTS:

Among 676 patients treated with anti-TNF (infliximab or adalimumab), the incidence of psoriasis was 10.7% (N = 72). Female gender (OR 1.88 [95% CI 1.12-3.17], p = 0.017), stricturing or fistulizing Crohn's disease (OR 1.83 [95% CI 1.04-3.21], p = 0.036) and upper GI Crohn's disease (OR 3.03 [95% CI 1.06-8.33], p = 0.039) were associated with psoriasis development. The median time to psoriasis onset was 569 days from initiation of anti-TNF, with onset occurring earlier in patients who developed psoriasis on adalimumab versus infliximab (457 vs. 790.5 days, p = 0.008). Overall, in 15/72 (20.8%), cases, cessation of the anti-TNF was required as a result of psoriasis. Plaque psoriasis was the most common type of psoriatic lesion (75%). Topical corticosteroids were the most common treatment for psoriasis.

CONCLUSION:

We report a high incidence of anti-TNF-associated psoriasis that was associated with female gender, foregut disease location, and fistulizing and stricturing disease behavior. More prospective studies and genetic analyses evaluating possible pathophysiologic underpinnings of this problem are needed.

KEYWORDS:

Anti-tumor necrosis factor; Crohn’s disease; Epidemiology; Inflammatory bowel disease; Psoriasis; Ulcerative colitis

PMID:
29736839
DOI:
10.1007/s10620-018-5096-2

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