Case Report of Secukinumabuse in Psoriatic Arthritis

Abstract

Background: There are very few case reports of Secukinumab use in psoriatic arthritis. Most patients with psoriatic arthritis benefit from anti-TNF therapy but some do not respond, therefore unmet needs remain. Secukinumab is a fully human monoclonal antibody that selectively neutralizes circulating IL-17a. Research suggests that IL-17a may play an important role in psoriasis, psoriatic arthritis and ankylosing spondylitis. Objective(s): To discuss the use of Secukinumab use in psoriatic arthritis. Method(s): A 76 years old male, non smoker, non alcoholic, was diagnosed as psoriatic arthritis 3 years back on the basis of psoriatic skin rash, asymmetrical polyarthritis including distal interphalangeal joints and asymmetric sacroiliitis with raised inflammatory markers. He was allergic to sulphasalazine and intolerant to methotrexate. He was given leflunomide 20 mg daily but he did not responded well to it and therefore anti-TNF agent subcutaneous injection etanercept 50 mg weekly was added to it. He responded well and remains stable for about 2.5 years but any attempt to taper anti TNF resulted in recurrence of symptoms and signs, so patient was continued on same dose. In spite of regular and adequate dose of etanercept and leflunomide, patient developed skin rash on dorsum of both hands associated with gradually increasing inflammatory type of low back pain and polyarthralgia from last 3 months. On examination his tender joint count (TJC) was 15/68, swollen joint count (SJC) was 0/66,without any deformity, Patients pain score was 6/10 score, patient global assessment score was 8/10, with increase in CRP-32 mg/L, ESR-41 mm/h, Disease Activity in PSoriatic Arthritis (DAPSA)-32.2 (High activity). Secondary anti-TNF Failure was considered and etanercept was stopped. Patient was shifted to subcutaneous injection Secukinumab 300 mg every weekly for 4 weeks than monthly, he responded very well within one month, with disappearance of rash and improvement in back pain without any side effect. His DAPSA score significantly improved from 32.2 (high activity) to 2.3 (remission) with marked dermatological improvement. Results and Conclusion(s): Secukinumab showed efficacy among patients who had received previous anti-TNF therapy and it is especially useful in Anti-TNF related problems like unacceptable side-effect, primary failure, secondary failure, and immunogenicity.