Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease. Biological therapy has revolutionized it's the treatment. Paradoxical HS occur with various biological and targeted agents. We report a patient with juvenile rheumatoid arthritis who developed HS after 6 months of tofacitinib therapy. A comprehensive literature review identified 43 cases of paradoxical HS among patients on biological and targeted agents. Pooled analysis of the cases showed Crohn's disease 18(41.8%) and RA 9(20.9%) as commonest indications for biological therapy. Adalimumab 20(46.5%) followed by infliximab 9(20.9%) were the commonest offending agents. Duration of biological treatment prior to HS manifestation was 12(1-120) months. Smoking 21(48.8%) and overweight or obese 20(46.5%) were most frequent HS risk factors. Fourteen (32.6%) patients had a second paradoxical event, 11(25.6%) developed psoriasis and 4(9.3%) Crohn's disease. Presence of ≥1 risk factor for HS, continuation of the implicated biological agent and occurrence of more than one paradoxical event were factors associated with poor paradoxical HS outcome.
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised three parts: (3) management of latent TB in preparation for anti-TNF therapy, (4) monitoring during anti-TNF therapy, and (5) management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asian Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection, and prevention of latent TB infection and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised two parts: (i) risk of TB infection during anti-TNF therapy and (ii) screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.