The efcacy of tumor necrosis factor inhibitors (TNFi) for the treatment of psoriasis is well established, but patients may
develop psoriasis for the frst time while on TNFi as a paradoxical efect. Limited data on this association in patients with
juvenile idiopathic arthritis (JIA) are available. Safety data from patients registered to the German Biologics registry (BiKeR)
were analyzed. Patients were grouped by treatment regime: single TNFi, multiple TNFi, non-TNFi biologics or bDMARDnaïve control group receiving methotrexate. TNFi-associated psoriasis was defned as incident diagnosis of psoriasis after
starting TNFi treatment. Patients with a history of psoriasis or psoriasis arthritis prior to TNFi therapy were excluded.
Event rates using AEs reported after frst dose were compared by Wald’s test. A total of 4149 patients were treated with a
TNFi (etanercept, adalimumab, golimumab, infiximab), 676 with a non-TNFi biologic (tocilizumab, abatacept, anakinra,
canakinumab) and 1692 with methotrexate only. A total of 31 patients were diagnosed with incident psoriasis while on one
of the above treatments. Compared with methotrexate, psoriasis was more frequent in the TNFi cohorts (RR 10.8, p=0.019),
specifcally in the subgroup of TNF antibodies (RR 29.8, p=0.0009), whereas no signifcant signal was observed with etanercept. Also, non-TNFi-treated patients presented high incident psoriasis rates (RR 25.0, p=0.003). Our fndings indicate a
higher rate of incident psoriasis in JIA patients treated with TNFi monoclonal antibodies or non-TNFi biologic treatment. JIA
patients receiving monoclonal antibody TNFi or non-TNFi bDMARD should be monitored for incident psoriasis. Medication
change, if topical skin treatment remains insufcient, may be considered.