Development of a psoriatic arthritis - like presentation under anti - IL-13 therapy with tralokinumab for atopic dermatitis.

Meridor, K.; Lee, SY.; Blee, I.; Freeston, JE.; Laws, PM.; De Marco, G.; Abacar, K.; Macleod, T.; Rowbotham, E.; Palmer, T.; Di Matteo, A.; Woolf, R.; Smith, C.; Pink, A.; Marzo-Ortega, H.; Kirkham, B.; McGonagle, D.

Development of a psoriatic arthritis - like presentation under anti - IL-13 therapy with tralokinumab for atopic dermatitis.

All Authors

Meridor, K.

Lee, SY.

Blee, I.

Freeston, JE.

Laws, PM.

De Marco, G.

Abacar, K.

Macleod, T.

Rowbotham, E.

Palmer, T.

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LTHT Author

Freeston, Jane
Laws, Philip
De Marco, Gabriele
Rowbotham, Emma
Palmer, Timothy
Di Matteo, Andrea
Marzo-Ortega, Helena
McGonagle, Dennis

LTHT Department

NIHR Leeds Biomedical Research Centre
Rheumatology
Dermatology
Radiology
Pathology
Histopathology

Publication Date

2025

Item Type

Journal Article

Abstract

OBJECTIVES: Dual blockade of IL-4 and IL-13 in atopic dermatitis (AD) has been associated with activation of the IL-23/IL-17 axis, potentially leading to paradoxical psoriasis and psoriatic arthritis (PsA)-like presentation. However, the specific cytokine responsible for these reactions remains unclear. We report a case series of PsA-like presentation following treatment with tralokinumab, an anti-IL-13 monoclonal antibody used for AD. METHODS: We identified four patients who developed a PsA-like presentation affecting the joints, entheses, and, in some instances, the skin, following tralokinumab initiation for AD. Clinical features, laboratory findings, imaging results, and treatment outcomes were assessed. RESULTS: Among 139 patients treated with tralokinumab across two large UK referral centers, four developed new-onset PsA-like presentation with inflammatory arthritis and enthesitis that emerged after tralokinumab initiation. All four had previously failed dupilumab therapy. Skin biopsies and joint imaging confirmed PsA-like features. Symptoms began weeks to months after starting tralokinumab and resolved following treatment withdrawal or modification. CONCLUSION: To our knowledge, this is the first case series documenting arthritis and enthesitis associated with anti-IL-13 therapy, suggesting a potential pathogenetic role of IL-13 inhibition in the development of PsA-like presentation. These findings warrant further investigation.