背景:肿瘤坏死因子α(TNFα)是参与某些炎性疾病发病的关键细胞因子,如类风湿性关节炎(RA),脊椎关节病,和炎症性肠病。在过去的二十年里,TNFα抑制剂(TNFi)彻底改变了上述疾病的治疗和结果。然而,TNFi的使用与许多自身免疫现象和矛盾的皮肤表现的发展相关,这些症状可能与TNFi有效使用的临床适应症类型相同.因此,它们可能表现为关节炎,葡萄膜炎,结肠炎,牛皮癣,和其他一些皮肤临床表现,其中包括湿疣的发展,局限性硬皮病皮肤病变。
方法:我们描述了一名58岁的女性,患有血清阴性RA,甲氨蝶呤难治,他接受了ABP-501(Hefiya)治疗,阿达木单抗(ADA)生物仿制药发展成椭圆形,约3.5cm大小的深层皮肤损伤,在开始治疗3个月后,影响她背部的左侧部分与角膜相容。ADA生物仿制药停产,两个月后,她的皮肤有了很大的改善.
结论:这是在TNFi生物仿制药期间首次报道的硬伤表现,因为患者没有其他硬伤发展的触发因素,如创伤和感染。治疗使用TNFi生物仿制药的患者的医生应该意识到矛盾的皮肤反应,在他们当中,密切监测,一分钟和仔细的临床检查,和后续检查是必需的。
BACKGROUND: Tumor necrosis factor alpha (TNFα) is a pivotal cytokine involved in the pathogenesis of certain inflammatory diseases, such as rheumatoid arthritis (RA), spondyloarthropathies, and inflammatory bowel diseases. In the last two decades, TNFα inhibitors (TNFi) have revolutionized the treatment and outcome of the above disorders. However, the use of TNFi has been associated with the development of many autoimmune phenomena and paradoxical skin manifestations that may present as the same type of clinical indications for which the TNFi effectively used. Thus, they may display as arthritis, uveitis, colitis, psoriasis, and several other cutaneous clinical manifestations, among them the development of morphea, a localized scleroderma skin lesion.
METHODS: We describe a 58-year-old woman with seronegative RA, refractory to methotrexate, who was treated with ABP-501 (Hefiya), an adalimumab (ADA) biosimilar and developed an oval-shaped, deep skin lesion of approximately 3.5cm in size, affecting the left part of her back compatible with morphea 3 months after the initiation of therapy. ADA biosimilar was discontinued and two months later, she had substantial skin improvement.
CONCLUSIONS: This is the first report of morphea manifestation during TNFi biosimilar since the patient had no other trigger factors for morphea development like trauma and infections. Physicians dealing with patients treated with TNFi biosimilars should be aware of paradoxical skin reactions, among them morphea; thus, close monitoring, a minute and careful clinical examination, and a follow- up check are required.