Plaque psoriasis and psoriatic arthritis associated with uveitis and cystoid macular edema treated with adalimumab: A case report and literature review
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Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury in Olsztyn, Poland
Department of Rheumatology, Municipal Hospital in Olsztyn, Poland
Department of Ophthalmology, Municipal Hospital in Olsztyn, Poland
Agnieszka Owczarczyk-Saczonek   

Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, Wojska Polskiego 30, 10-229 Olsztyn, Poland. Tel.: +48 89 6786670; fax: +48 89 6786675.
Submission date: 2016-10-03
Acceptance date: 2016-11-07
Online publication date: 2017-03-20
Publication date: 2020-03-22
Pol. Ann. Med. 2017;24(2):249–255
Psoriatic patients, especially with psoriatic arthritis (PsA), are more prone to metabolic disorders and involving the eyes.

The aim of this study was to present adalimumab efficacy of several aspects of psoriasis and its comorbidities.

Case study:
Wepresent a 48-year-old male patient with severe plaque psoriasis and psoriatic arthritis who developed uveitis with cystoid macular edema in the right eye. The patient was obese although bariatric surgery 8 years earlier produced someweight loss with remission of diabetes and hypertension.

Results and discussion:
The patient had been previously treated with systemic treatment with no improvement in psoriatic arthritis symptoms and skin lesions but rapidly responded to adalimumab. At week 8, the patient achieved the PASI 75, with no joint pain and normal macular architecture. At week 16, there was an incident of atrial fibrillation followed by a transient ischemic attack (TIA). The TIA subsided after intravenous fluids and antithrombotic treatment although acute urticaria developed after the first dose of acetylsalicylic acid. Adalimumab treatment was not stopped and the patient's condition continued to improve.

After careful consideration of the patient's underlying and comorbid conditions and previous treatment failures, adalimumab was instituted and continued since (1) its efficacy in psoriasis and psoriatic arthritis is well-documented; (2) obesity is not thought to affect its effectiveness; (3) in uveitis adalimumab acts quickly and induces long-term remission; (4) a significant improvement of hemostasis and fibrynolytic balance has been observed in patients on TNF-a inhibitors and adalimumab could be continued after the TIA.

The authors have no conflict of interest.
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