Combination therapy of infliximab and granulocyte/monocyte adsorption apheresis for refractory pustular psoriasis with psoriatic arthritis.

© 2013 The Authors. doi: 10.2340/00015555-1463 Journal Compilation © 2013 Acta Dermato-Venereologica. ISSN 0001-5555 Infliximab, a chimeric monoclonal immunoglobulin G (IgG) antibody against tumour necrosis factor alpha (TNF-α), is effective in patients with psoriasis, including pustular psoriasis and psoriatic arthritis (1). Infliximab results in a Psoriasis Area Sensitivity Index (PASI) 75 remission in 79% of psoriatic patients by 10 weeks of treatment, and this effect persists in 74% and 53% of patients at 6 and 12 months, respectively (2). Efficacy is lost by various means, sometimes by development of antibodies to infliximab, which occurs in 19% of patients (2). Co-medication with methotrexate is recommended to improve efficacy or to reduce the development of antibodies to infliximab, especially in psoriatic arthritis (3). However, methotrexate could not be given to our patient due to previous adverse effects of the drug. Granulocyte/monocyte adsorption therapy (GMA) was originally used weekly as an effective therapy for ulcerative colitis, for a total of 10 sessions, and is also an effective treatment for pustular psoriasis (4, 5); this therapy involves the removal of activated leukocytes from the peripheral blood and other undefined mechanisms. We report here a case of pustular psoriasis with psoriatic arthritis, in which remission was successfully achieved with a combination of infliximab and GMA.