Tumor Necrosis Factor Inhibition Increases Psoriasis Incidence in Children with JIA

A study presented at American College of Rheumatology (ACR) Convergence 2021 meeting found an increased risk of psoriasis after tumor necrosis factor inhibitor (TNFi) usage among children with juvenile idiopathic arthritis (JIA). 

“Paradoxical psoriasis has been increasingly reported in adults after exposure to TNFi. Systematic studies in the pediatric population are lacking,” wrote the study authors.

The researchers used the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry to analyze 8,222 patients with JIA and without a history of psoriasis or inflammatory bowel disease. New onset psoriasis was defined as the first recorded instance of psoriasis following diagnosis with JIA.

Patients were aged a median of 7.5 years at JIA diagnosis. The cohort was 29% male. Median follow-up was 5.3 years. Fifty-four percent of patients (n = 4,435) were prescribed TNFis.

The hazard ratio (HR) for new onset of psoriasis after first exposure to TNFi was 3.02 (95% confidence interval [CI], 2.26 to 4.02, P < 0.01). When adjusted for methotrexate exposure, sex, face, family history of psoriasis, and initial JIA category, the HR for new onset psoriasis was 2.93 (95% CI, 2.15 to 3.98, P < 0.01).

The researchers noted that the incidence of psoriasis was highest among children receiving adalimumab versus other TNFis. Additionally, patients with psoriatic arthritis receiving TNFis demonstrated an elevated risk of psoriasis; however, this risk was lower than observed in patients in all other JIA categories (HR = 1.68 vs. 5.60, respectively).

“In a large prospective JIA patient registry, we observed a nearly 3-fold increased risk of psoriasis after TNFi exposure,” the authors wrote. “Increasing awareness of this unwanted side effect in pediatric community is important to ensure timely diagnosis and treatment.”

Reference: Zhao y, et al. Psoriasis Rate Is Increased by the Exposure to TNF Inhibition in Children with JIA. Arthritis Rheumatol. 2021;73(suppl 10). Presented at ACR Convergence 2021 (Virtual), Nov. 5 to 9, 2021.