Progressive Alopecia Areata During TNF-Alpha Inhibition With Intralesional Corticosteroid Failure and Subsequent Improvement Following JAK1 Inhibition

A 55-year-old woman with seropositive rheumatoid arthritis developed progressive alopecia areata (AA) while on golimumab and leflunomide treatment, despite well-controlled arthritis. Her alopecia worsened over 14 months with intralesional corticosteroid treatment, as indicated by an increase in her Severity of Alopecia Tool (SALT) score from 20 to 50. Upon switching to the JAK1 inhibitor upadacitinib, her hair regrowth began within six weeks, and her SALT score improved to 15 by three months. This case suggests that JAK1 inhibition may be an effective treatment for AA that develops during TNF-α inhibitor therapy, although spontaneous remission and delayed effects of corticosteroids cannot be ruled out.