Paradoxical psoriatic arthritis flare with the initiation of brodalumab and guselkumab

Paradoxical plaque psoriasis reactions have been reported with biologics, primarily with the use of anti-tumor necrosis factor (TNF) agents. Brodalumab (Siliq, Valeant Pharmaceuticals), a human monoclonal antibody against interleukin (IL)-17 receptor A (IL17RA), has been proven to be effective against psoriasis and psoriatic arthritis (PsA).1 Guselkumab (Tremfya, Janssen Biotech), an interleukin 23 blocker, has also been proven to be effective in treating moderate to severe psoriasis and PsA.2 Guselkumab has been recently approved by the United States Food and Drug Administration to treat PsA.