Rapid dramatic improvement of pustulotic arthro-osteitis by guselkumab in a patient with palmoplantar pustulosis: a real-world experience

A 59-year-old female with palmoplantar pustulosis (PPP) of 20 years' duration was referred to our hospital. Although she had been treated with topical corticosteroid ointment, skin lesions had waxed and waned during this time period. She was a past smoker (three cigarettes a day for 1 year), but quit smoking soon after she was diagnosed as PPP. She occasionally had a sore throat when she was a child. Her mother also had PPP. The patient further developed arthralgia involving the left clavicle two years previously. Physical examination showed palmoplantar erythema with scales and a small number of pustules and vesiculopustules (Fig. Skin atrophy due to long-term topical corticosteroid therapy was also observed. She did not have acne. Laboratory examination showed slight increases in inflammatory markers (C-reactive protein; 2.0 mg/dl, erythrocyte sedimentation rate; 34 mm/h); however, anti-thyroid, microsome, and nuclear antibodies were all within normal limits. Examination using technetium-99m bone scintigraphy revealed increased uptake in the left clavicle (Fig. Otolaryngological examination revealed tonsillar hypertrophy. For joint pain, non-steroidal anti-inflammatory drugs (NSAIDs), methotrexate (6 mg/week) for 10 months, and cyclosporine (100-200 mg/day) for 8 months were administered, all of which resulted in little effect. The patient refused tonsillectomy, and guselkumab was initiated for severe joint pain. A few days after the first subcutaneous injection of guselkumab (100 mg), the patient's joint pain was dramatically improved, and NSAIDs were not needed. Her visual analogue scale score for joint pain was decreased to 0.