Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jan;14(1):59-81.
doi: 10.1007/s13555-023-01082-z. Epub 2024 Jan 6.

Drug- or Vaccine-Induced/Aggravated Psoriatic Arthritis: A Systematic Review

Yao-Tsung Yeh  1 , Tsen-Fang Tsai  2
Affiliations
Review

Drug- or Vaccine-Induced/Aggravated Psoriatic Arthritis: A Systematic Review

Yao-Tsung Yeh et al. Dermatol Ther (Heidelb). 2024 Jan.

Abstract

Introduction: Drugs and vaccines have been less studied as inducing or aggravating factors for psoriatic arthritis (PsA) compared with psoriasis. Thus, the present study collected and summarized the publications to date about this issue.

Methods: We conducted a systematic literature search through the PubMed, Embase, and Cochrane databases to identify all reports on potential drug- and vaccine-related PsA events until 28 February 2023.

Results: In total, 179 cases from 79 studies were eligible for study. Drugs commonly reported include coronavirus disease 2019 (COVID-19) mRNA vaccines (6 cases), bacillus Calmette-Guerin (BCG) vaccine (3 cases), interferon (18 cases), immune-checkpoint inhibitors (ICI) (19 cases), and biologic disease-modifying antirheumatic drugs (bDMARDs) (127 cases). Drugs causing psoriasis may also induce or aggravate PsA (6 cases). BDMARD-related PsA mostly occurred in a "paradoxical" setting, in which the bDMARDs approved for the treatment of psoriasis induce or aggravate PsA. The reported latency may be delayed up to 2 years. Peripheral arthritis (82.3%) was the most common manifestation of drug- and vaccine-related PsA, followed by dactylitis (29.1%), enthesitis (23.4%), and spondyloarthritis (17.7%).

Conclusions: Drugs and vaccines may be implicated in the aggravation of PsA. Possible mechanisms include cytokine imbalance, immune dysregulation, or inadequate PsA treatment response compared with psoriasis. Most reports are case based without controls, so more studies are needed to further prove the causality. However, early recognition of factors causing or aggravating PsA is important to prevent the irreversible joint damage.

Keywords: Aggravated; De novo; Drug; Induced; New onset; Psoriatic arthritis; Vaccine.

PubMed Disclaimer

Conflict of interest statement

Yao-Tsung Yeh has no conflicts of interest to disclose. Tsen-Fang Tsai has conducted clinical trials or received honoraria for serving as a consultant for Abbvie, AnaptysBio, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli-Lilly, Galderma, GSK, Janssen-Cilag, Leo Pharma, Merck Sharp & Dohme, Novartis International, Pfizer, PharmaEssentia, Sanofi, Sun Pharma and UCB Pharma.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the literature search and strategy for the selection of relevant studies
Fig. 2
Fig. 2
Mean latency to arthritis event (vaccine- and specific drug-related PsA)
Fig. 3
Fig. 3
Mean latency to paradoxical PsA events
Fig. 4
Fig. 4
Proportions of drug-induced paradoxical PsA (except efalizumab)
Fig. 5
Fig. 5
Scheme of drug- and vaccine-induced/aggravated PsA, created with Biorender.com
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251–265. doi: 10.1016/j.jaad.2018.06.027. - DOI - PubMed
    1. Chao J-P, Tsai T-F. Psoriasis flare following ChAdOx1-S/nCoV-19 vaccination in patients with psoriasis under biologic treatment. Dermatol Sin. 2021;39(4):208–209. doi: 10.4103/ds.ds_45_21. - DOI
    1. Zabotti A, De Lucia O, Sakellariou G, et al. Predictors, risk factors, and incidence rates of psoriatic arthritis development in psoriasis patients: a systematic literature review and meta-analysis. Rheumatol Ther. 2021;8(4):1519–1534. doi: 10.1007/s40744-021-00378-w. - DOI - PMC - PubMed
    1. Tsankov N, Angelova I, Kazandjieva J. Drug-induced psoriasis. Recognition and management. Am J Clin Dermatol. 2000;1(3):159–165. doi: 10.2165/00128071-200001030-00003. - DOI - PubMed
    1. Grzelj J, Sollner DM. The role of xenobiotics in triggering psoriasis. Arch Toxicol. 2020;94(12):3959–3982. doi: 10.1007/s00204-020-02870-8. - DOI - PubMed