Paradoxical Psoriatic Arthritis with the Initiation of Brodalumab and Guselkumab

Paradoxical plaque psoriasis reactions have been reported with the usage of biologics, primarily with the use of anti-TNF agents. Brodalumab, a human monoclonal antibody against interleukin-17 receptor A (IL17RA), and, guselkumab, an interleukin-23 blocker, are biologic agents that have been proven to be effective against psoriasis and psoriatic arthritis. We report a case of a 47 year old white male with a long standing history of psoriatic arthritis with worsening plaque psoriasis who was placed on brodalumab and guselkumab, separately, for control of his cutaneous manifestations. He experienced an unusual severe worsening of arthritis in a longstanding psoriasis and psoriatic arthritis within days of starting brodalumab, and subsequently within days of starting guselkumab despite a significant clearing of plaque psoriasis. Both reactions subsided after cessation of the offending agent. Paradoxical reactions caused by these newer biologics are unusual. Psoriatic arthropathy has been reported as an insignificant adverse effect in the literature for brodalumab but has not been reported for guselkumab. Additionally, paradoxical psoriatic arthritis flares usually occur de novo rather than a worsening of previous disease, as seen in our patient. In summary, this case highlights previously undescribed adverse reaction associated with the initiation of both brodalumab and guselkumab that one should be aware of.https://scholarlycommons.henryford.com/merf2020caserpt/1066/thumbnail.jp

The Epidemiology of Melanoma in Wayne County: A Preliminary analysis of Racial Disparities

Objective: Melanoma is a cutaneous malignancy accounting for 75% of all skin cancer deaths but can be cured if discovered early. Although individuals of lighter skin tones are more likely to develop melanoma, studies have found that African American populations have a worse prognosis than their Caucasian counterparts. Many epidemiological analyses have been done assessing the general characteristics of melanoma nationally and the racial disparities surrounding this malignancy, but a specific study outlining the regional characteristics of Wayne County has yet to be done. Methods: The Surveillance, Epidemiology, and End Results database was used to populate a cohort of 3,922 patients diagnosed with melanoma from 2000-2016 in Wayne County. Statistics were generated with the SEER*Stat software. Results: Of the 3,922 patients diagnosed with melanoma from 2000-2016 in Wayne County, 2266 (58.6%) were male and 1656 (42.2%) were female. The racial distribution consisted of 3,771 (96%) white, 102 (2.6%) black and 39 (1.25%) classified as other or unknown. The stage of diagnosis for the entire cohort was reported as 3252 (82.9%) localized, 386 (9.8%) regional and 191 (4.9%). When stratified by race, black patients had a higher rate of regional and distant tumors (21.5% and 22.5% respectively) than white patients (9.6% and 4.5% respectively). A chi squared analysis on this variable outlined a statistically significant difference in stage of diagnosis between white and black patients (X2 = 102.841, p\u3c 0.00001). Additionally, a t-test outlined a statistically significant difference in survival months between white and black patients (p Conclusion: Despite higher incidence of melanoma among Caucasians in Wayne County, prognosis for Black patients is worse as indicated by stage of diagnosis and survival months. Standardized protocols and local programs need to be in place to improve health literacy and education among these patients to identify melanoma earlier and improve overall outcomes