Doctors note unusual side effects with anti-TNF medications

Drs. Jacob Aelion and S.K. Odhav of the Jackson Arthritis Clinic noted an unusual side effect in rheumatoid arthritis patients treated with a class of medications known as anti-TNFs.

Some of these patients developed a rare form of psoriasis on the palms of their hands, the soles of their feet, or on both places.
In mid November, Drs. Aelion and Odhav, to-gether with Dr. Miriam Aelion from the Department of Dermatology at the University of Tennessee Memphis, presented a paper titled “Use of Anti-TNF-Alpha Drugs and Incidence of Palmo-Plantar Psoriasis in Patients with Rheumatoid Arthritis” at the American College of Rheumatology National meeting.

Psoriasis is a relatively common, non-contagious skin disease characterized by raised red patches or blisters covered with a silvery white buildup of dead skin cells. Psoriasis limited to the palms and soles, also known as palmo-plantar psoriasis, makes up only three percent of the total cases of psoriasis.

“The abstract was very well received,” said Dr. Odhav. “Several rheumatologists at the meeting recalled seeing patients with similar reactions.”

This is the fourth time in two and a half years that Dr. Aelion and Dr. Odhav have presented interesting, original, clinical findings at national and international professional meetings. “This helps put the Jackson medical community on the map,” Dr. Odhav says.

Dr. Aelion explained why this latest abstract drew the attention of some of the best medical school professors from this county and Europe:

“Anti-TNFs are widely used by rheumatologists and dermatologists in the treatment of rheumatoid arthritis and psoriasis. The fact that drugs used to treat psoriasis may actually cause the condition when used in patients with rheumatoid arthritis, gives im-munologists and other basic scientists another angle in their quest to better understand the genetic and/or other causes behind these two autoimmune diseases.”

The first observation by the Jackson physicians was made in 1999. “At that time, we thought it was an allergic reaction to one of the drugs,” said Dr. Aelion. “However, with time, we noticed the phenomenon in other patients treated with various Anti-TNFs.”

So far, they have had eight rheumatoid arthritis patients develop palmo-plantar psoriasis following treatment with infliximabs, adalimumab, and etanercept, which are generic names for three FDA-approved, anti-TNF drugs. None of the patients had a family history of psoriasis. The skin condition was confirmed by skin biopsies read by certified dermatopathologists.

Withdrawal of the drug led to remission of the skin condition in three of the patients. Some of the patients chose to keep taking the therapy because of its efficacy in controlling the symptoms of rheumatoid arthritis.

“Deciding between living with the pain of rheumatoid arthritis or a painless skin condition was a no-brainer,” said one of the patients.

“I hope this interesting observation is another step in the understanding of rheumatoid arthritis and psoriasis, and will help researchers come up with better treatment options in these two autoimmune conditions,” says Dr. Aelion.
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