Paradoxical plaque psoriasis reactions have been reported with the usage of biologics, primarily with the use of anti-TNF agents. Brodalumab, a human monoclonal antibody against interleukin-17 recepto..
Paradoxical plaque psoriasis reactions have been reported with the usage of biologics, primarily with the use of anti-TNF agents. Brodalumab, a human monoclonal antibody against interleukin-17 receptor A (IL17RA), and, guselkumab, an interleukin-23 blocker, are biologic agents that have been proven to be effective against psoriasis and psoriatic arthritis. We report a case of a 47 year old white male with a long standing history of psoriatic arthritis with worsening plaque psoriasis who was placed on brodalumab and guselkumab, separately, for control of his cutaneous manifestations. He experienced an unusual severe worsening of arthritis in a longstanding psoriasis and psoriatic arthritis within days of starting brodalumab, and subsequently within days of starting guselkumab despite a significant clearing of plaque psoriasis. Both reactions subsided after cessation of the offending agent. Paradoxical reactions caused by these newer biologics are unusual. Psoriatic arthropathy has been reported as an insignificant adverse effect in the literature for brodalumab but has not been reported for guselkumab. Additionally, paradoxical psoriatic arthritis flares usually occur de novo rather than a worsening of previous disease, as seen in our patient. In summary, this case highlights previously undescribed adverse reaction associated with the initiation of both brodalumab and guselkumab that one should be aware of.