Treating Psoriatic Dactylitis with TNF-Alpha Inhibitors Like Remicade Improves Symptoms, Report Shows

Treating Psoriatic Dactylitis with TNF-Alpha Inhibitors Like Remicade Improves Symptoms, Report Shows

New research suggests that symptoms of psoriatic dactylitis, a manifestation of psoriatic arthritis (PsA), can be improved with therapies that promote the inhibition of TNF-alpha, one of the most important molecular players in inflammation.

The study, “Severe Psoriatic Dactylitis: When Psoriasis Involves Beyond The Skin,” was published in Reumatismo, the journal of the Italian Society of Rheumatology, and conducted by Dr. Husein Husein-ElAhmed, MD, from Guadix Hospital in Spain.

Psoriatic arthritis is a form of inflammatory arthritis in patients with psoriasis. Symptoms include leg and arm arthritis and inflammation in the spine and sacroiliac joints (axial disease), the tendons or ligaments (enthesitis), and in the digits (dactylitis).

PsA is a progressive, debilitating disease that negatively impact patients at their psychological, social, and functional levels. It can significantly impair patients’ ability to work and their quality of life.

To date, no clinical trials have been designed to treat PsA, but physicians usually prescribe analgesic anti-inflammatory drugs, local corticosteroid injections, and immune system inhibitors such as methotrexate, cyclosporine, and azathioprine.

But these drugs haven’t always achieved the desired effect, which led Husein-ElAhmed to study the effect of TNF-alpha therapies.

In his study, Husein-ElAhmed reported the case a 57-year-old male farmer with a history of hypertension and psoriasis with swelling and pain in the joints between the fingers, morning stiffness, signs of severe dactylitis such as “sausage fingers” with abnormal thickening and detachment of the nails (hyperkeratosis and onycholysis, respectively), and psoriatic scaly plaques in the palms and soles. Due to these disabling symptoms, the patient had not been able to work for a year.

The man had been treated with Trexall (methotrexate) and later with Imuran (azathioprine) for three months, but both drugs were ineffective. He was then administered Remicade (infliximab), a TNF-alpha inhibitor, which significantly decreased the morning stiffness, pain and swelling. Based on these positive results, infusions of Remicade were given every eight weeks.

“The patient is back at work and no relapse has been observed during the two years of follow-up,” the author wrote in his report. “This case highlights the notable impact of dactylitis on workplace and quality of life in psoriatic patients and the efficacy of the TNF-alpha therapies in cases where outcomes are not satisfactory with classic drugs.”

Husein-ElAhmed believes that clinical trials for psoriatic dactylitis should be considered, as they would provide more information on the best therapies to avoid remission and bone damage associated with this condition.

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