Rheumatoid arthritis patients on TNFi at high risk of developing psoriasis

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder primarily attacking the joints, affecting between 0.5 and 1% of the world population. Rheumatoid arthritis is characterized by joint pain, tenderness, swelling, and joint stiffness. While the cause of Rheumatoid arthritis is not certain, risk factors include genetics, smoking, obesity, sex, and age. Similar to other autoimmune diseases, RA predominantly affects females, with a 2:1 to 3:1 female to male ratio. While RA can develop at any age, typical onset occurs between 30 and 50 years. RA is commonly treated with immunosuppressants such as methotrexate, hydroxychloroquine, sulfasalazine, or leflunomide, T-cell costimulatory inhibitors such as abatacept, interleukin-6 receptor (IL-6R) antibodies such as tocilizumab, Janus kinase (JAK) inhibitors, and tumor necrosis factor (TNF) inhibitors such as certolizumab pegol, adalimumab, golimumab, infliximab, and etanercept4.

This adverse event is counterintuitive since some tumor necrosis factor inhibitors are indicated for the treatment of plaque psoriasis. In this study, we analyzed over 880 thousand postmarketing safety reports from patients being treated for Rheumatoid arthritis with a single therapeutic and provided evidence for a statistically significant association of psoriasis adverse events with TNF inhibitor use as compared to methotrexate.