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Psoriatic arthritis (PsA) is an immune-mediated inflammatory disease of the skin and joints still poorly understood in pediatric patients. It has been reported a case report of PsA in a male infant patient in Paraiba state, Northeast Brazil. The goal of this study was describing a rare case of juvenile PsA and its management upon using classical and biologic treatment based on the drug etanercept. The patient was diagnosed with scales on the scalp, knees and other parts of the body and joint inflammation besides social behavior deficit since he was aged 5. Classical therapy to PsA including acitretrin and topical glucocorticoids did not ameliorate the illness symptoms. Then, the patient received the anti-TNF-α drug etanercept used to treat moderate to severe psoriasis and juvenile rheumatoid arthritis. Before the week 16 of the treatment was observed a strong remission of the symptoms which is related to the inhibition of the inflammatory response into skin and joints. Besides no side effects was observed during etanercept administration. This study indicates that anti-TNF-α therapy might be used to treat immune-mediated inflammation likely to PsA in pediatric patients.
Keywords: Juvenile patient, psoriatic arthritis, biologic therapy
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2. Hagberg KW, Li L, Peng M, et al. Rates of Cancers and Opportunistic Infections in Patients With Psoriatic Arthritis Compared With Patients Without Psoriatic Arthritis. Journal of Clinical Rheumatology.2016; 22: 241-247.DOI: 10.1097/RHU.0000000000000364.
3. Prussick R, Prussick L, Nussbaum D. Nonalcoholic Fatty Liver Disease and Psoriasis What a Dermatologist Needs to Know. The Journal of Clinic and Aesthetic Dermatology.2015; 8(3):43-45.
4. Marinoni B, Ceribelli A, Massarotti MS, et al. The Th17 axis in psoriatic disease: pathogenetic and therapeutic implications. Autoimmunity Highlights. 2014; 5:9-19.DOI: 10.1007/s13317-013-0057-4.
5. Ogdie A, Weiss P. The Epidemiology Psoriatic Arthritis.Rheumatic Disease Clinics of North America. 2015; 41(4): 545-568.
6. Horneff G, Burgos-Vargas R, Constantin T, et al. Efficacy and safety of open-label etanercept on extended oligoarticular juvenile idiopathic arthritis, enthesitis-related arthritis and psoriatic arthritis: part 1 (week 12) of the CLIPPER study. Annals of the Rheumatic Diseases.2014; 73:1114-1122.
7. Sritheran D, Leung YY. Making the next steps in psoriatic arthritis management: current status and future directions.Therapeutic Advances in Musculoskeletal Diseases.2015; 7(5): 173-186.
8. Tanaka, Y. Current concepts in the management of rheumatoid Arthritis. The Korean Journal of Internal Medicine.2016; 31:210-218.
9. Giancane G, Consolaro A, Lanni S et al. Juvenile Idiopathic Arthritis: Diagnosis and Treatment. Rheumatology and Therapy.2016; 3:187-207.
10. Meglio PD, Villanova F, Nestle FO. Psoriasis.Cold Spring Harbor Perspective of Medicine. 2014; 4:a015354.
11. Harden JL, Krueger JG, Bowcock A. The Immunogenetics of Psoriasis: A Comprehensive Review. Journal of Autoimmunity. 2015. 64: 66-73.
12. Torsekar R, Gautam MM. Topical Therapies in Psoriasis. Indian Dermatology Online Journal. 2017; 8(4): 235-245.
13. Joo-Heung Lee, Jai-Il Youn, Tae-Yoon Kim et al. A multicenter, randomized, open-label pilot trial assessing the efficacy and safety of etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly, the combination of etanercept 25 mg twice weekly and acitretin, and acitretin alone in patients with moderate to severe psoriasis. BMC Dermatology. 2016; 16 (11): 2-9.
14. Smith EMD, Foster HE, Beresford MW. The development and assessment of biological treatments for children.Britsh Journal of Clinical Pharmacology. 2014; 79 (3): 379-394.
15. Bronckers IM, Paller AS, Van Geel MJ et al. Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities. Pediatric Drugs.2015; 17:373-384.
16. Lahdenne P, Vähäsalo P, Honkanen V. Infliximab or etanercept in the treatment of children with refractory juvenile idiopathic arthritis: an open label study. Annals of the Rheumatic Diseases.2003; 62: 245-247.
17. Fotiadou C, Lazaridou E, Ioannides D. Management of psoriasis in adolescence. Adolescent Health, Medicine and Therapeutics.2014; 5: 25-34.
18. Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis.Seminars in Arthritis and Rheumatism.2017; 47:351-360.
19. Ayala-Fontánez N, Soler DC, McCormick TS. Current knowledge on psoriasis and autoimmune diseases. Psoriasis: Targets and Therapy. 2016; 6: 7-32.
20. Johnston A, Fritz Y, Dawes SM, et al. Keratinocyte Overexpression of IL-17C Promotes Psoriasiform Skin Inflammation. The Journal of Immunology.2013; 190: 2252-2262.
21. Pinson R, Sotoodian B, Fiorillo L. Psoriasis in children. Psoriasis: Targets and Therapy. 2016; 6: 121-129.
22. Udommethaporn S, Tencomnao T, McGowan EM, et al. Assessment of Anti-TNF-α Activities in Keratinocytes Expressing Inducible TNF- α: A Novel Tool for AntiTNF-α Drug Screening. PLoS ONE. 2016; 11(7): e0159151.
23. Kivelevitch D, Mansouri B, Menter A. Long term efficacy and safety of etanercept in the treatment of psoriasis and psoriatic arthritis. Biologics: Targets and Therapy. 2014; 8: 169-182.
24. Calzada-Hernández J, Anton-López J, Bou-Torrent R, et al. Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study. Pediatric Rheumatology. 2015; 13 ( 54):1-6.
25. Xiong W, Dong H, Wang J, et al. Analysis of Plasma Cytokine and Chemokine Profiles in Patients with and without Tuberculosis by Liquid Array-Based Multiplexed Immunoassays. PLoS ONE. 2016; 11(2): e0148885.