Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases

Arthritis Care Res (Hoboken). 2021 Feb;73(2):215-220. doi: 10.1002/acr.24100. Epub 2021 Jan 3.


Objective: To estimate the incidence rate (IR) of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor inhibitor (TNFi) exposure as compared to children without TNFi exposure and to the general pediatric population.

Methods: This was a single-center retrospective cohort study of children with IBD, JIA, or CNO from 2008 to 2018. TNFi exposure was defined as a prescription for adalimumab, etanercept, infliximab, certolizumab, or golimumab, and the primary outcome was incident psoriasis. IRs and standardized incidence ratios (SIRs) were calculated. Cox proportional hazards models were used to assess the association of psoriasis with TNFi exposure and other risk factors.

Results: Of the 4,111 children who met inclusion criteria, 1,614 (39%) had TNFi exposure and 2,497 (61%) did not, with 4,705 and 6,604 person-years of follow-up, respectively. There were 58 cases (IR 12.3 per 1,000 person-years) and 25 cases (IR 3.8 per 1,000 person-years) of psoriasis in children with and without TNFi exposure, respectively. The SIR was 18 (95% confidence interval [95% CI] 15-22) overall, 30 (95% CI 23-39) for children with TNFi exposure, and 9.3 (95% CI 6.3-14) for children without TNFi exposure. The hazard ratio of psoriasis comparing TNFi exposure to no TNFi exposure was 3.84 (95% CI 2.28-6.47; P < 0.001).

Conclusion: Children with IBD, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.

MeSH terms

  • Adolescent
  • Age Factors
  • Arthritis, Juvenile / diagnosis
  • Arthritis, Juvenile / drug therapy*
  • Arthritis, Juvenile / immunology
  • Child
  • Chronic Disease
  • Databases, Factual
  • Female
  • Humans
  • Incidence
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / drug therapy*
  • Inflammatory Bowel Diseases / immunology
  • Male
  • Osteomyelitis / diagnosis
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / immunology
  • Psoriasis / chemically induced*
  • Psoriasis / diagnosis
  • Psoriasis / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • Tumor Necrosis Factor Inhibitors / adverse effects*


  • Tumor Necrosis Factor Inhibitors