Paradoxical skin lesions induced by anti-TNF-α agents in SAPHO syndrome

  • Chen Li
  • Xia Wu
  • Yihan Cao
  • Yueping Zeng
  • Weihong Zhang
  • Shuo Zhang
  • Yuehua Liu
  • Hongzhong Jin
  • Wen Zhang
  • Li Li
Original Article


The objectives of the study were to characterize the clinical picture of paradoxical skin lesions in SAPHO patients treated with anti-TNF-α agents and to explore its pathogenesis. Patients treated with anti-TNF-α therapy were identified from a cohort of 164 SAPHO patients. The clinical data and skin biopsies were collected. The usage, efficacy, and side effects of anti-TNF-α therapy were recorded. Forty-one (25.0%) patients received anti-TNF-α therapy, of which seven (17.1%) developed paradoxical skin lesions after 1 to 14 infusions. Patients with such lesions were older at onset of skin lesions than those without (p = 0.034). Expression of TNF-α in palmoplantar pustulosis increased after anti-TNF-α therapy in the two examined patients with exacerbated skin lesions. Anti-TNF-α therapy induces paradoxical skin lesions in 17.1% SAPHO patients. Late onset of skin manifestations is associated with an increased risk of such lesions. The paradoxical elevation of TNF-α expression in lesions may contribute to this phenomenon.


Age of onset Palmoplantar pustulosis Psoriasiform lesions SAPHO syndrome Side effects Tumor necrosis factor-α inhibitor 


Funding information

This study was supported by China National Natural Science Funds (No. 81371731) and the Capital Medical Research and Development Fund (No. 2016-4-40112), the Education Reform Projects of Peking Union Medical College (No. 2016zlgc0106), the CAMS Initiative for Innovative Medicine (No. 2017-I2M-3-001), and the National Key Research and Development Program of China (No. 2016YFC0901500).

Compliance with ethical standards

The study was approved by the Ethics Committee of Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences (ethics documents number ZS-944). All individual participants provided written informed consent to participate in this cohort at the time of inclusion.



Supplementary material

10067_2018_4083_MOESM1_ESM.pdf (92 kb)
Online Resource 1 (PDF 91 kb)
10067_2018_4083_MOESM2_ESM.pdf (75 kb)
Online Resource 2 (PDF 75 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Chen Li
    • 1
  • Xia Wu
    • 2
  • Yihan Cao
    • 2
  • Yueping Zeng
    • 2
  • Weihong Zhang
    • 3
  • Shuo Zhang
    • 2
  • Yuehua Liu
    • 2
  • Hongzhong Jin
    • 2
  • Wen Zhang
    • 4
  • Li Li
    • 2
  1. 1.Department of Traditional Chinese MedicinePeking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
  2. 2.Department of DermatologyPeking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
  3. 3.Department of RadiologyPeking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
  4. 4.Department of RheumatologyPeking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical SciencesBeijingChina

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