PMC8687500_01
Clinical images showing the improvement in deformities 1 week (upper photograph), 2 weeks (middle photograph) and 1 month (bottom photograph) after the induction phase of secukinumab. The improvements in palmar and plantar tactile sensitivity and related pain were also impressive. Each color represents the lightest tactile sensation felt by esthesiometry (gram-force (gf)): blue circle = 0,2 gf; purple circle = 2,0 gf; full red circle = 4,0 gf; red x = 10 gf; white circle with red edges = 300 gf; black circle = absence of sensitivity.
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PMC8687500_01_1678-9849-rsbmt-54-e0336-2021-gf1.jpg
f1
Immunobiological therapy was maintained weekly, following the psoriatic arthritis induction dosing schedule until week 5, after which a monthly dose with consistent reductions in prednisone (from daily 80 mg to daily 20 mg in 5 weeks) was administered, and progressive clinical improvement was observed (Figure 1).
Graph showing basal levels of the measured cytokines after the first corticosteroid pulse and during possible tachyphylaxis. There were reductions in IFN-gamma, TNF-alpha, IL-17A, and IL-12/23p40 levels after the induction phase of secukinumab concomitant with expressive clinical improvements.
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Figure 2 shows an evident loss of therapeutic effectiveness after the third pulse of corticosteroids, which may be attributed to tachyphylaxis and the posterior modulation of IFN-gamma, TNF-alpha, IL-17A, and IL-12/23p40 after secukinumab induction.