Journal Information
Vol. 16. Issue 4.
Pages 303-305 (July - August 2020)
Vol. 16. Issue 4.
Pages 303-305 (July - August 2020)
Images in Clinical Rheumatology
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Linear localized morphea associated with golimumab in a patient with spondyloarthritis
Morfea lineal asociada al uso de golimumab en paciente con espondiloartropatía
Vicenç Torrente-Segarraa,
Corresponding author

Corresponding author.
, Pedro Campob, Sergi Herediaa, Cristina Heras-Mulerob, Maria Boneta
a Servicio de Reumatología, Hospital Comarcal Alt Penedès, Vilafranca del Penedès, Barcelona, Spain
b Servicio de Dermatología, Hospital Comarcal Alt Penedès, Vilafranca del Penedès, Barcelona, Spain
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Table 1. Patient data with combined morphea and anti-TNF usage condition: review of the literature.
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A 58 year old Caucasian women, with HLA-B27-positive mixed involvement spondyloarthritis (rachialgia and sacroiliac pain, both bilateral inflammatory with onset at the age of 21 currently with radiographic grade IV sacroiliitis associated with peripheral arthropathy of the small joints in the hands, ankles and metatarsophalanges with onset at the age of 55 years), in addition to previous repeated episodes of uveitis (4 episodes which abated with no sequelae), refractory to treatment with non-steroidal anti-inflammatory drugs, systemic corticoids at intermediate doses, methotrexate and leflunomide. In September 2015 treatment was initiated with golinmumab (anti-TNF alpha), resulting in a complete improvement of symptoms. The patient was symptom-free until July 2017 when she presented with symptoms compatible with linear localized morphea in lower limbs (Fig. 1) with no other concomitant infectious or neoplastic condition, confirmed by skin biopsy (fibrosing sclerodermiform dermatitis). This association in patients with immune-mediated diseases has been described but in highly exceptional cases. Following review of the literature, we found 6 similar cases, which are described in Table 1.1–6 We therefore believe that the presentation of morphea in a patient treated with anti-TNF alpha may be considered a possible condition associated with its use, even if presentation is not immediate and is infrequent, and that it should be taken into account by professionals who use these therapies.

Fig. 1.

Multiple images of lower limb linear distribution indurated plaques, compatible with linear localised morphea: (A and B) sclerotic plaques with a pearly cream or whitish centre and violacious erythematous periphery, oedematous in lower left limb, compatible with active lesion; (C) image A lesion with demonstrable induration when pressed digitally; (D and E) extensive whitish scar-like plaques in the lower right limb, compatible with non active lesion.

Table 1.

Patient data with combined morphea and anti-TNF usage condition: review of the literature.

Author  SexAgeRace  Anti-TNF alpha type  Interval from initiation of anti-TNF until beginning of morphea (weeks)  Immune-mediated disease  Distribution  Compatible Biopsy  Resolution after withdrawal of anti-TNF alpha (treatment) 
Matozzi C, et al.1  Woman17Caucasican  Adalimumab  12  Crohn  Abdomen (injection site)  Yes  Yes, complete (topical) 
Stewart FA, et al.2  Man45Caucasian  Etanercept  78  Psoriasis  Abdomen (injection site and trunk  Yes  Yes, with minimal progression (topical) 
Ranganathan P3  Woman52Afro-American  Infliximab  14  Rheumatoid arthritis  Neck, trunk, upper extremities  Not undertaken  Yes, partial (topical) 
Ramírez J, et al.4  Man37Caucasian  Adalimumab  52  Ankylosing spondylitis  Lower Extremities  Yes  Yes, partial (topical) 
Inoue-Nishimoto T, et al.5  Woman42Asian  Adalimumab  26  Psoriasis  Trunk and pelvic girdle  Yes  Yes, partial (topical) 
Chimenti MS, et al.6  Man54Caucasian  Etanercept  156  Rheumatoid arthritis  Trunk and abdomen  Yes  Yes, partial (rituximab) 
Conflict of interests

The authors have no conflict of interests to declare.

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Please cite this article as: Torrente-Segarra V, Campo P, Heredia S, Heras-Mulero C, Bonet M. Morfea lineal asociada al uso de golimumab en paciente con espondiloartropatía. Reumatol Clin. 2020;16:303–305.

Copyright © 2018. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
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