Successful treatment of psoriatic onycho-pachydermo periostitis (POPP) with adalimumab

Arthritis Rheum. 2005 Jan;52(1):280-2. doi: 10.1002/art.20763.


Psoriatic onycho-pachydermo periostitis (POPP) is recognized as a rare subset of psoriatic arthritis, characterized by psoriatic onychodystrophy, connective tissue thickening above the distal phalanx, and a periosteal reaction. Therapy for this rare disease is based on treatments used for psoriatic arthritis, but traditional disease-modifying antirheumatic drugs, such as sulfasalazine and methotrexate, have shown inconsistent and unsatisfactory results. We report herein a successful therapeutic approach for POPP using the fully human anti-tumor necrosis factor (TNF) antibody adalimumab in a 42-year-old male patient. After 4 months of anti-TNF treatment, a remarkable normalization of the clinical appearance was achieved and magnetic resonance imaging showed complete resolution of the initial inflammatory lesions. Therefore, we consider a TNF-blocking strategy as promising for treatment of POPP.

Publication types

  • Case Reports

MeSH terms

  • Adalimumab
  • Adult
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Arthritis, Psoriatic / diagnosis
  • Arthritis, Psoriatic / drug therapy*
  • Arthritis, Psoriatic / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Periostitis / diagnosis
  • Periostitis / drug therapy*
  • Periostitis / pathology
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / immunology*


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Tumor Necrosis Factor-alpha
  • Adalimumab