Highly active form of psoriatic arthritis on top of pemphigus vulgaris and its successful treatment with secukinumab
Abstract
Authors describe a case of a patient with long-term treatment of pemphigus vulgaris with combined immunosuppressive treatment (cyclophosphamide + glucocorticoids) that experienced the manifestation of psoriasis and severe psoriatic arthritis with polyarticular disorder despite this treatment. At first, the patient was treated with 25 mg of methotrexate a week parenterally in combination with glucocorticoids per os and in the form of intra-articular injections into active joints; the therapy with cyclophosphamide was terminated.
This intensive therapy brought only mild improvement and biologic therapy was indicated after treatment failure three months later. Standard choice is anti-TNFα therapy; however, due to preceding long-term treatment with cyclophosphamide and a possible potentiation of malignancy risk with combination of cyclophosphamide and TNFα inhibitor, secukinumab was selected as a first-line agent together with parenteral methotrexate.
The therapy was very successful; significant improvement was observed in first weeks and remission of psoriatic arthritis and complete regression of psoriasis was achieved and maintained even after the termination of corticoid therapy. The treatment was very well tolerated by the patient; no severe adverse effects or relapse of pemphigus were observed.