Can Dupixent cause psoriatic arthritis?: A Closer Look at the Evidence

October 14, 2025 •

3 min read

While not reported in initial clinical trials, post-marketing surveillance and case reports have described new-onset psoriatic arthritis-like symptoms in some patients taking Dupixent. This has prompted a closer look at the potential for Dupixent cause psoriatic arthritis, particularly in those with pre-existing inflammatory conditions.

Quick Summary

Case reports and observational studies have linked Dupixent to new or worsening arthritis, though a direct causal link is not established. This may relate to a shift in immune response.

Key Points

Immune Shift Hypothesis: Dupixent blocks the IL-4 and IL-13 pathways, which may inadvertently activate the Th17 pathway linked to psoriatic disease.
Limited Causality: While case reports document new psoriatic arthritis-like symptoms, large observational studies have not established a statistically significant causal link.
Symptoms Often Resolvable: Joint pain can begin days to months after starting treatment and may resolve after stopping Dupixent or be managed with other medications.
Not Universal: The reaction is considered rare and does not affect the majority of Dupixent users.
Requires Monitoring: Patients experiencing new joint pain, enthesitis, or morning stiffness should inform their doctor for evaluation and appropriate management.

While Dupixent (dupilumab) was not associated with joint problems in its initial clinical trials, reports emerging from post-marketing surveillance and individual case studies have raised questions about its potential to cause or trigger psoriatic arthritis. Dupixent is a biologic medication primarily approved for conditions like atopic dermatitis (eczema) and asthma, and the appearance of new, PsA-like symptoms in some patients is an unexpected side effect. This article explores the current understanding of this phenomenon, including the proposed immune mechanism, clinical evidence, and how patients should respond to new joint symptoms.

The Immunological Balancing Act

Dupixent works by blocking the signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13), two key proteins involved in the type 2 inflammatory response. By inhibiting this pathway, Dupixent effectively treats type 2 inflammatory diseases like atopic dermatitis. However, the human immune system is a complex and finely tuned network. The leading hypothesis for why Dupixent might cause psoriatic disease centers on an unintended shift in the immune balance. By suppressing the Th2 pathway (driven by IL-4 and IL-13), the immune system may overcompensate by increasing activity in the Th17 pathway, which is centrally involved in the pathogenesis of psoriasis and psoriatic arthritis. Case reports describing the concurrent development of both psoriasis-like rashes and inflammatory arthritis support this theory.

Clinical Evidence: Case Reports and Observational Studies

The initial evidence linking Dupixent to new psoriatic arthritis comes from individual case reports and small-scale observational studies. These reports describe patients, often with atopic dermatitis, who develop musculoskeletal symptoms after starting dupilumab. Examples include patients developing enthesitis (inflammation where tendons and ligaments attach to bone), arthritis, and tenosynovitis, which are characteristic of psoriatic arthritis. Some individuals with atopic dermatitis have experienced a shift to a psoriasiform presentation involving both skin and joints after starting Dupixent. Specific cases highlight the varied presentation and response, with some patients seeing symptoms resolve after stopping Dupixent, while others require additional treatment.

Large-Scale Studies and Statistical Significance

Large-scale studies offer a broader perspective. A 2025 study in JAMA Dermatology found an increased risk for psoriasis in atopic dermatitis patients treated with dupilumab, but the risk for psoriatic arthritis was not statistically significant. A 2023 study in JAAD also found no significant increase in the risk of joint pain or inflammatory arthritis during the first 6 months of dupilumab use in a cohort of 4,000 patients. These studies suggest a low absolute risk for Dupixent causing psoriatic arthritis, despite some data showing an elevated relative risk.

What to Do If Joint Pain Occurs

Patients on Dupixent who develop new or worsening joint pain should contact their healthcare provider. Management depends on the symptom severity. Mild pain might be treated with NSAIDs, while moderate to severe symptoms may lead to discontinuing Dupixent and possibly a referral to a rheumatologist. Symptoms may resolve after stopping Dupixent, or require other treatments.

Comparison of Dupixent-Related Arthralgia and Psoriatic Arthritis


Feature	Dupixent-Associated Arthralgia	Typical Psoriatic Arthritis (PsA)
Symptom Onset	Days to months after starting Dupixent	Variable; can develop slowly over time or suddenly
Affected Joints	Can be generalized, or localized to a few joints initially	Often involves asymmetric joint inflammation, especially small joints of fingers and toes
Immune Mechanism	Hypothesized Th2 to Th17 immune shift	Characterized by Th1/Th17 pathway activation
Resolution	May resolve after stopping Dupixent	Chronic, progressive disease requiring long-term management
Associated Symptoms	Can occur with or without accompanying new-onset psoriasis	Typically associated with psoriatic skin and/or nail changes

Conclusion

While Dupixent is an effective treatment for type 2 inflammatory conditions, the possibility of new-onset psoriatic arthritis-like symptoms is a recognized, albeit not fully understood, adverse event. The evidence suggests a potential paradoxical immune effect rather than a direct cause. The overall risk appears low, but vigilance for new musculoskeletal symptoms is important for both clinicians and patients. Decisions about continuing Dupixent should involve weighing the treatment benefits against any joint-related side effects.

JAMA Dermatology Psoriasis Risk in Patients with Atopic Dermatitis Treated with Dupilumab

Frequently Asked Questions

No, the development of psoriatic arthritis-like symptoms while on Dupixent is considered a rare, paradoxical adverse event.

You should contact your doctor immediately to report the symptoms. Depending on the severity, your doctor may recommend managing the pain with other medication, or discontinuing Dupixent.

Yes, depending on the severity. Mild symptoms may be managed with NSAIDs, while more severe or persistent cases might require discontinuing Dupixent and potentially using alternative treatments like JAK inhibitors.

In some reported cases, symptoms of inflammatory arthritis have resolved after discontinuing Dupixent. However, some cases require further treatment.

No, Dupixent is not indicated for the treatment of psoriatic arthritis. It is used for atopic dermatitis, asthma, nasal polyps, and eosinophilic esophagitis.

Dupixent-induced arthralgia is a potential adverse reaction to the drug that can mimic psoriatic arthritis. While the symptoms may be similar, it is believed to be caused by a different, drug-induced immune shift. True psoriatic arthritis is a chronic, progressive inflammatory disease.

It is hypothesized that by blocking the IL-4 and IL-13 pathways, Dupixent can cause a shift in the immune system that enhances activity in the Th17 pathway, which is associated with psoriasis and psoriatic arthritis.