A novel approach with tofacitinib for the management of keratoderma blennorrhagicum in reactive arthritis: a case report

Front Immunol. 2024 Jul 2:15:1399249. doi: 10.3389/fimmu.2024.1399249. eCollection 2024.

Abstract

Reactive arthritis(ReA), a form of arthritis occurring post-infection, manifests with antecedent infection symptoms, arthritis, and extra-articular manifestations, categorizing it as spondyloarthritis. "Keratoderma blennorrhagicum" (characterized by pustular hyperkeratosis on palms and soles, resembling pustular psoriasis) represents the most typical skin manifestation of ReA, occurring in acute or chronic phases. Severe lesions necessitate systemic disease modifying anti-rheumatic drugs (DMARDs) or biologic therapies. This article reports a case of ReA with sacroiliitis and widespread pustular eruptions following a urinary tract infection. Treatment with sulfasalazine and thalidomide significantly improved sacroiliitis, but the skin rash remained persistent and recurring. Subsequent use of adalimumab and secukinumab resulted in worsening skin rash, prompting a switch to tofacitinib, leading to a remarkable improvement in pustular eruptions after 20 days of treatment. This case demonstrates successful application of tofacitinib in treating severe keratoderma blennorrhagicum refractory to conventional DMARDs and biologics, offering insights into JAK inhibition for challenging rheumatic diseases with skin involvement.

Keywords: JAK inhibitors; Reiter’s syndrome; keratoderma blennorrhagicum; reactive arthritis; tofacitinib.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Reactive* / drug therapy
  • Arthritis, Reactive* / etiology
  • Female
  • Humans
  • Janus Kinase Inhibitors / therapeutic use
  • Male
  • Piperidines* / therapeutic use
  • Protein Kinase Inhibitors / therapeutic use
  • Pyrimidines* / therapeutic use
  • Treatment Outcome

Substances

  • tofacitinib
  • Piperidines
  • Pyrimidines
  • Antirheumatic Agents
  • Protein Kinase Inhibitors
  • Janus Kinase Inhibitors

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Guangdong Basic and Applied Basic Research Foundation of Guangdong Province, China (Grant No. 2019A1515011094); the Guangdong Basic and Applied Basic Research Foundation of Guangdong Province, China (Grant No. 2022A1515010471); the Guangzhou Science and Technology Planning Project of Guangdong Province, China (Grant No. 202102010139); Multi-center clinical research Project Fund of the Second Affiliated Hospital of Guangzhou Medical University of Guangdong Province, China (Grant No. 2022-LCYJ-YYDZX-05).