INTERLEUKIN-17INHIBITION WITH SECUKINUMAB IMPROVES SUDOMOTOR DYSFUNCTION IN PSORIATIC ARTHRITIS

Ashit Syngle,Tanya Syngle,Inderjeet Verma,Sudeep Kaur

doi:10.22159/ijpps.2018v10i3.22660

Abstract

Psoriatic arthritis (PsA) is a relapsing inflammatory disease, most commonly a seronegative oligoarthritis found in patients with psoriasis, characterized by the absence of rheumatoid factor in serum, with differentiating features of distal joint involvement and in extreme cases of arthritis mutilans (which is a destructive form of PsA). Cardiovascular autonomic and peripheral sympathetic neuropathy occurs in PsA. However, there is no specific treatment recommendation for autonomic neuropathy (AN) in psoriatic diseases. Secukinumab, a recently approved therapeutic advancement for psoriasis and psoriatic arthritis, is an immunoglobulin G (IgG) 1k fully monoclonal antibody that selectively inhibits the effector function of interleukin (IL)-17A. Its effect on sudomotor dysfunction in PsA has not yet been reported. This is the first reported observation of improvement in peripheral sympathetic autonomic neuropathy with secukinumab in PsA. We report a case of a 52-year-old male with PsA on methotrexate 15 mg/week with severe disease activity treated with the addition of subcutaneous secukinumab 150 mg once a week for 5 w followed by once a month dose. We found significant improvement in sudomotor dysfunction after 4 and 8 w of treatment.

Highlights

A skin and joint disease with multifactorial etiology, psoriasis affects 1-2% of the general population [1]
Interleukin 17A and its receptor are expressed in synovial tissues and as such the interleukin 17 pathway is proposed to contribute to the pathogenesis of psoriatic arthritis [4]
We have shown in this case with active psoriatic arthritis a significant improvement in inflammatory disease activity and sudomotor dysfunction along with resolution of autonomic symptoms after treatment with secukinumab

Summary

INTRODUCTION

A skin and joint disease with multifactorial etiology, psoriasis affects 1-2% of the general population [1]. Peripheral sympathetic autonomic dysfunction in psoriatic arthritis is known [2]. In addition to PsA, the patient had light-headedness and disturbed bowel movements suggestive of autonomic dysfunction. He is a teetotaler and a non-smoker. He is normotensive and non-diabetic and does not have thyroid dysfunction He had an elevated erythrocyte sedimentation rate (ESR) of 73 mm/1st hr and high C-reactive protein (CRP) of 25 mg/dl and DAS-28 (Disease Activity Score in 28 joints) score was 6.3 (table 1). ESR; erythrocyte sedimentation rate, CRP; C-reactive protein, DAS-28; disease activity score of 28 joints, HAQ-DI; health assessment questionnaire. After the first dose of Secukinumab 150 mg subcutaneous, there was a rapid improvement in autonomic symptoms and sudomotor dysfunction After 4 and 8 w treatment with secukinumab, there was a great improvement in the quality of life assessed by HAQ-DI (table 1)

DISCUSSION

CONCLUSION