A 30-year-old woman presented with a 20-year history of guttate psoriasis affecting approximately 25% of her body surface area. Her psoriasis was associatedwith psoriatic arthritis manifested by lower back pain with 1 hour of morning stiffness. Her arthritic symptoms correlated with worsening skin disease.Both her psoriasis and psoriatic arthritis were refractory to treatment with methotrexate (30 mg orally every week) for 3 months, then cyclosporine (4mg/kg orally every day) for 2 months, and subsequently methotrexate and cyclosporine taken concomitantly for 2 months. She was next treated with infliximab administeredintravenously at a dose of 5 mg/kg combined with methotrexate (30 mg orallyevery week). Her psoriasis completely cleared after 3 infusions of infliximabadministered over 2 months. Her lower back pain persisted. She received additional infliximab infusions every 2 months while the methotrexate was slowly discontinued.
Strober BE. Successful Treatment of Psoriasis and Psoriatic Arthritis With Etanercept and Methotrexate in a Patient Newly Unresponsive to Infliximab. Arch Dermatol. 2004;140(3):366. doi:10.1001/archderm.140.3.366
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