JAK Inhibitors May Relieve Skin Manifestations of axSpA

Patients with complex inflammatory diseases such as axial spondyloarthritis (axSpA) should be screened for skin manifestations regularly, advises a review article published online in the Indian Journal of Dermatology, Venereology and Leprology.

“Cutaneous manifestations in spondyloarthritis add additional morbidity and impose a psychosocial burden on affected patients,” wrote authors Ansaam Daoud, MD, and Marina N. Magrey, MD, of the department of rheumatology at Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio.

The review focuses on the efficacy of Janus kinase (JAK) inhibitors reported in major studies of patients with axSpA. In patients with an inadequate response to tumor necrosis factor inhibitors, tofacitinib and upadacitinib are approved for axSpA. Both have been shown to improve pain, disease activity, physical function, and quality of life, although prescribers should exercise caution in patients with cardiovascular risk, smokers, and those older than 65 years because of safety concerns, according to the review. Data from major trials on the effectiveness of JAK inhibitors for cutaneous manifestations remains to be published.

“AxSpA-associated dermatologic manifestations like psoriasis, pyoderma gangrenosum, erythema nodosum, cutaneous Crohn’s disease, hidradenitis suppurativa, keratoderma blenorrhagicum, or balanitis circinate were not evaluated as outcomes in these studies…,” researchers wrote. “In the future, these cutaneous manifestations are expected to be studied as secondary outcomes.”

Nevertheless, several published reports support the effectiveness of tofacitinib and upadacitinib for psoriasis, enthesitis, pyoderma gangrenosum, and hidradenitis suppurativa, the review noted.

“Thus, in appropriate clinical scenarios, JAK inhibitors may also provide adequate relief for the associated inflammatory cutaneous manifestations of axSpA,” the authors wrote.

Reference
Daoud A, Magrey MN. Efficacy and safety of Janus kinase inhibitors in axial spondyloarthritis. Indian J Dermatol Venereol Leprol. Published online June 21, 2023. doi:10.25259/IJDVL_161_2023