Anakinra in Pyoderma Gangrenosum

July 22, 2015

A case report describes the use of anakinra in a patient with psoriatic arthritis in whom pyoderma gangrenosum developed. The ulcer had not responded to any other therapies.

Acquitter M, Plantin P, Kupfer I, et al. Letters: Anakinra Improves Pyoderma Gangrenosum in Psoriatic Arthritis: A Case Report. Ann Intern Med. 7 July 2015;163(1):70-71. doi:10.7326/L15-5107

 

A 46-year-old woman with a history of psoriasis and symmetrical, destructive axial and peripheral polyarthritis developed a painful, deep ulcer in the left leg. Pyoderma gangrenosum was diagnosed.

The ulcer did not respond to oral prednisone, increased methotrexate, oral dapsone, intravenous methylprednisolone, etanercept, or ustekinumab.

The ulcer continued to worsen and eventually exposed tendons and circled the leg.

Her doctors started anakinra, 100 mg daily, and noticed improvement after 15 days, with the appearance of granulation tissue. The ulcer continued to heal during the next 3 months. Anakinra was discontinued for 5 months so surgery could be performed, and the leg worsened. Finally, 7 months later, anakinra was resumed and the ulcer continued to heal.

Also see: First-Line Rx in Pyoderma Gangrenosum