INTERLEUKIN-17INHIBITION WITH SECUKINUMAB IMPROVES SUDOMOTOR DYSFUNCTION IN PSORIATIC ARTHRITIS
Keywords:Psoriatic arthritis, Sudomotor dysfunction, Secukinumab, Autonomic neuropathy, Psoriasis
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.
Khopkar U, Pandey S. Skin manifestations of rheumatic diseases. In: Syngle A, Deodhar SD. editors. Rheumatology principles and practice. 1st ed. Jaypee Brothers Medical Publisher; 2010. p. 413.
Syngle A, Verma I, Garg N, Krishan P. Autonomic dysfunction in psoriatic arthritis. Clin Rheumatol 2013;32:1059-64.
Mclnnes IB, Mease PJ, Kirkham B, Kavanaugh A, Ritchlin CT, Rahman P, et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015;386:1137-46.
FitzGerald O, Winchester R. Emerging evidence for the critical involvement of interleukin-17 pathway in both psoriasisl and psoriatic arthritis. Arthritis Rheumatol 2014;66:1077-80.
Zilliox L, Peltier AC, Wren PA, Anderson A, Smith AG, Singleton JR, et al. Assessing autonomic dysfunction in early diabetic neuropathy: the survey of autonomic symptoms. Neurology 2011;76:1099-105.
Mayaudon H, Miloche PO, Bauduceau B. A new method for assessing sudomotor function: relevance in type 2 diabetes. Diabetes Metab 2010;36:450-4.
HalÄ±gur BD, Cicek D, Bulut S, Berilgen MS. The investigation of autonomic functions in patients with psoriasis. Int J Dermatol 2012;51:557-63.
Boulton AJ, Freeman R, Vinik AI. Diabetic neuropathies: a statement by the American diabetes association. Diabetes Care 2005;28:956-62.
Milovanovic B, Stojanovic L, Nebojsa Milicevic N, Vasic K, Bjelakovic B, Krotin M. Cardiac autonomic dysfunction in patients with systemic lupus, rheumatoid arthritis and sudden death risk. Srp Arh Celok Lek 2010;138:26-32.
Szodoray P, Alex P, Chappell-Woodward CM, Madland TM, Knowlton N, Dozmorov I, et al. Circulating cytokines in Norwegian patients with psoriatic arthritis determined by a multiplex cytokine array system. Rheumatology 2007;46:417-25.
Truchetet ME, Mossalayi MD, Boniface K. IL-17 in the rheumatologist's line of sight. Biomed Res Int 2013. http://dx.doi.org/10.1155/2013/295132
Kellner H. Targeting interleukin 17 in patients with active rheumatoid arthritis: rationale and clinical potential. Adv Musculoskelet Dis 2013;5:141-52.
Raychaudhuri SP, Raychaudhuri SK. Mechanistic rationales for targeting interleukin-17A in spondyloarthritis. Arthritis Res Ther 2017;19:51.
Toussirot E, Bouhaddi MB, Poncet JC, Cappelle S, Henriet MT, Wendling D, et al. Abnormal autonomic cardiovascular control in ankylosing spondylitis. Ann Rheum Dis 1999;58:481-7.
Levine JD, Goetzl EJ, Basbaum AI. The contribution of the nervous system to the pathophysiology of rheumatoid arthritis and other polyarthritides. Rheum Dis Clin North Am 1987;13:369-83.