{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:45:26Z","timestamp":1793371526721,"version":"4.5.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Psoriasis (PsO) and psoriatic arthritis (PsA) are increasingly recognized as manifestations within the spectrum of psoriatic disease, and emerging observational data suggest that biologic therapy targeting interleukin-23 (IL-23) may reduce the risk of incident PsA. This finding remains controversial given the potential for channeling and information bias. Here, we describe five patients with long-standing PsO who developed new-onset PsA while achieving excellent skin clearance with IL-23 or IL-12\/23 inhibitor therapy (risankizumab in four patients and ustekinumab in one). The time from the initiation of IL-23 pathway inhibition to PsA diagnosis ranged from 5 to 63 months. All patients met the ClASsification criteria for Psoriatic ARthritis, with musculoskeletal manifestations including dactylitis, synovitis, tenosynovitis, and enthesitis, and two patients had erosive changes on imaging. Joint symptoms improved in the majority of patients after transition to an IL-17-targeted biologic. These cases indicate that IL-23 pathway inhibition may not reliably prevent the onset of PsA and may contribute to its development in susceptible individuals. Thus, this series underscores the importance of ongoing musculoskeletal surveillance in patients with PsO receiving IL-23-targeted therapy, even when skin disease is completely controlled.<\/jats:p>","DOI":"10.3389\/fmed.2026.1962420","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:49:35Z","timestamp":1790743775000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical case series: Emergence of psoriatic arthritis during biologic IL-23 pathway inhibition therapy for psoriasis"],"prefix":"10.3389","volume":"13","author":[{"given":"Andrew Z.","family":"Li","sequence":"first","affiliation":[{"name":"Department of Dermatology, Perelman School of Medicine, University of Pennsylvania","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian D.","family":"Cooley","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris T.","family":"Derk","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubhasree","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis R.","family":"Ogdie","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelcie L.","family":"Molchany","sequence":"additional","affiliation":[{"name":"Nesbitt School of Pharmacy, Wilkes University","place":["Wilkes-Barre, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel M.","family":"Gelfand","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Perelman School of Medicine, University of Pennsylvania","place":["Philadelphia, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1038\/s41569-024-01097-9","article-title":"Cardiodermatology: the heart of the connection between the skin and cardiovascular disease","volume":"22","author":"Gelfand","year":"2024","journal-title":"Nat Rev Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s11926-015-0540-1","article-title":"Clinical risk factors for the development of psoriatic arthritis among patients with psoriasis: a review of available evidence","volume":"17","author":"Ogdie","year":"2015","journal-title":"Curr Rheumatol Rep"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.jaad.2018.11.058","article-title":"Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities","volume":"80","author":"Elmets","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1093\/rheumatology\/keab622","article-title":"Body surface area affected by psoriasis and the risk for psoriatic arthritis: a prospective population-based cohort study","volume":"61","author":"Ogdie","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e200","DOI":"10.1016\/S2665-9913(23)00034-6","article-title":"Association between biological immunotherapy for psoriasis and time to incident inflammatory arthritis: a retrospective cohort study","volume":"5","author":"Singla","year":"2023","journal-title":"Lancet Rheumatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/s40259-025-00705-5","article-title":"Interleukin-23 versus interleukin-17 inhibitors in preventing incidental psoriatic arthritis in patients with psoriasis: a real-world comparison from the TriNetX US collaborative network","volume":"39","author":"Yu","year":"2025","journal-title":"BioDrugs"},{"key":"B7","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1136\/annrheumdis-2021-220761","article-title":"Does biologic therapy impact the development of PsA among patients with psoriasis?","volume":"81","author":"Meer","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"B8","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jdcr.2021.01.014","article-title":"Paradoxical psoriatic arthritis flare with the initiation of brodalumab and guselkumab","volume":"10","author":"Kashlan","year":"2021","journal-title":"JAAD Case Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1111\/ced.15061","article-title":"Paradoxical psoriatic arthritis in a patient with psoriasis treated with guselkumab","volume":"47","author":"Carriero","year":"2022","journal-title":"Clin Exp Dermatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1038\/s41584-021-00706-y","article-title":"Does psoriasis treatment affect PsA development?","volume":"17","author":"Merola","year":"2021","journal-title":"Nat Rev Rheumatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"585134","DOI":"10.3389\/fimmu.2020.585134","article-title":"Interleukin (IL)-12 and IL-18 synergize to promote MAIT cell IL-17A and IL-17F production independently of IL-23 signaling","volume":"11","author":"Cole","year":"2020","journal-title":"Front Immunol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1002\/art.43095","article-title":"Metabolic stress expands polyfunctional, proinflammatory Th17 cells in patients with psoriatic arthritis for whom there is interleukin-23-independent interleukin-17 production","volume":"77","author":"Stober","year":"2025","journal-title":"Arthritis Rheumatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2491","DOI":"10.1084\/jem.20072707","article-title":"Blockade of tumor necrosis factor in collagen-induced arthritis reveals a novel immunoregulatory pathway for Th1 and Th17 cells","volume":"205","author":"Notley","year":"2008","journal-title":"J Exp Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"6291","DOI":"10.3390\/jcm12196291","article-title":"De Novo\u201d psoriasis and relapse of psoriasis induced by dupilumab: three new cases and review of the literature","volume":"12","author":"Trave","year":"2023","journal-title":"J Clin Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"623","DOI":"10.25259\/IJDVL_719_2023","article-title":"Paradoxical psoriasis induced by IL-17 antagonists","volume":"90","author":"Wang","year":"2024","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e439","DOI":"10.1111\/ajd.14584","article-title":"Retrospective review on safety and efficacy of combination biologic therapy for psoriasis","volume":"66","author":"Yoong","year":"2025","journal-title":"Australas J Dermatol"}],"container-title":["Frontiers in 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