Combination Therapy of Infliximab and Granulocyte/Monocyte Adsorption Apheresis for Refractory Pustular Psoriasis with Psoriatic Arthritis

Fujisawa, Tomomi; Moriya, Chie; Shibuya, Yoshinao; Kanoh, Hiroyuki; Seishima, Mariko

doi:10.2340/00015555-1463

Cited by 13 publications

(12 citation statements)

References 9 publications

(9 reference statements)

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“…33,34 This is consistent with the improvement of clinical symptoms in patients with psoriasis and PsA after depletion of CD14 + 16 ++ proinflammatory monocytes by adsorptive granulocyte and monocyte apheresis. 35,36 In our study, we did not find any significant changes in the numbers of T reg and Th17 between any studied group and no correlations of the cell numbers with clinical disease activity measurements. However, some animal models and in vitro studies suggested a dysregulation between anti -inflammatory T reg lymphocytes and proinflammatory Th17 lymphocytes, [37][38][39] as well as bilateral interactions between T reg and Th17 lymphocytes in these patients.…”

Section: Monocyte Subpopulation T Reg and Th17 Countscontrasting

confidence: 59%

Number of circulating non-classical (CD14+CD16++) monocytes negatively correlates with DAS28 and swollen joints count in peripheral spondyloarthritis patients

Guła¹,

Stec²,

Rutkowska-Zapała³

et al. 2017

Polish Archives of Internal Medicine

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INTRODUCTION A different clinical course and pattern of skeletal involvement in peripheral and axial spondyloarthritis (SpA) suggests a distinct pathophysiology of these 2 phenotypic manifestations of SpA. Monocytes, as part of the innate immune system, seem to play an important role in the pathogenesis of SpA, but the exact inflammatory pathways remain to be elucidated. Regulatory T lymphocytes (Treg) and Th17 lymphocytes are also known to influence proinflammatory and anti‑inflammatory reactions. OBJECTIVES The aim of our study was to compare the absolute numbers of monocyte subpopulations, Treg, and Th17 lymphocytes with clinical measures of disease activity in patients with peripheral and axial SpA. PATIENTS AND METHODS We enrolled 21 patients with peripheral SpA and 27 patients with axial SpA diagnosed according to the Assessment of SpondyloArthritis International Society classification criteria, as well as 23 healthy controls. Patients were under 45 years, naïve to synthetic and biological disease‑modifying antirheumatic drugs and without the administration of systemic glucocorticoids. The absolute numbers of classical, intermediate, nonclassical monocytes, Treg, and Th17 in peripheral blood were analyzed. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Disease Activity Score 28 (DAS28). RESULTS In patients with SpA, the number of circulating nonclassical monocytes was decreased in comparison with controls. Only in the peripheral SpA group, a significant negative correlation was found between the concentration of nonclassical monocytes and DAS28 and the number of swollen joints. The 3 groups did not differ in terms of the concentrations of classical or intermediate monocytes and Treg or Th17 lymphocytes. CONCLUSIONS Nonclassical monocytes may play a role in induction and perpetuation of peripheral joint inflammation, at least in peripheral SpA, as cells infiltrating the synovium.

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Section: Monocyte Subpopulation T Reg and Th17 Countscontrasting

confidence: 59%

Number of circulating non-classical (CD14+CD16++) monocytes negatively correlates with DAS28 and swollen joints count in peripheral spondyloarthritis patients

Guła¹,

Stec²,

Rutkowska-Zapała³

et al. 2017

Polish Archives of Internal Medicine

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“…GCAP was initially approved for the treatment of UC . Later, it was shown to be effective on various skin conditions, such as generalised pustular psoriasis, psoriatic arthritis, systemic lupus erythematosus skin rash, Behcet's disease and PG .…”

Section: Discussionmentioning

confidence: 99%

“…GCAP was initially approved for the treatment of UC (5-7). Later, it was shown to be effective on various skin conditions, such as generalised pustular psoriasis, psoriatic arthritis, systemic lupus erythematosus skin rash, Behcet's disease and PG (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The efficacy of GCAP has been reported in some patients with both PG and an inflammatory bowel disease (either UC or CD) (13,18,19), but only seven patients with PG have been successfully treated with this apheretic technique (14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment of pyoderma gangrenosum with granulocyte and monocyte adsorption apheresis

Russo

Miotto

Colpo

et al. 2016

International Wound Journal

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Pyoderma gangrenosum is a neutrophilic dermatosis clinically characterised by the presence of painful skin ulcerations with erythematous and undetermined borders and histologically by the presence of neutrophilic infiltrates in the dermis. Granulocyte and monocyte adsorption apheresis, also called granulocytapheresis, is a therapeutic strategy for extracorporeal immunomodulation that selectively removes activated granulocytes and monocytes/macrophages from the peripheral blood. Here, we report a case of a 73-year-old patient affected by a severe form of pyoderma gangrenosum presenting with multiple painful ulcers and pustules on his trunk and extremities. The disease was resistant to high doses of methylprednisolone and methotrexate and successfully treated by granulocyte and monocyte adsorption apheresis. To the best of our knowledge, this is the first report on the efficacy of granulocyte and monocyte adsorption apheresis in pyoderma gangrenosum in Europe.

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“…Recently, there have been some reports showing the efficacy of GMA for GPP (10,12,13), including a multi-center, prospective trial (12). The report indicates that good responses were obtained in 85.7% of the patients, and that 90.9% of the patients maintained a clinical response for 10 weeks after 5 GMA sessions, without any changes in their medications (12).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Granulocyte and Monocyte Adsorption Apheresis for Treatment of Palmoplantar Pustulosis

et al. 2014

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Palmoplantar pustulosis (PPP) is characterized by neutrophilic pustules with erythema, which are limited to the hands and feet. Although granulocyte and monocyte adsorption apheresis (GMA) has shown remarkable effects on generalized pustular psoriasis, there are few reports of PPP treated with GMA. We treated three refractory PPP patients using GMA weekly for 5 weeks. The skin eruptions were assessed by a 5-grade score for scales, pustules, and erythema. GMA decreased the total grade from 9 to 2 in patients 1 and 2, and from 7 to 3 in patient 3. The GMA effects were estimated to be excellent in all three patients. Pustule formation and pain disappeared in all cases. The treatment effect lasted for at least 5 months after GMA. GMA was also effective for relieving the arthralgia in one patient, but it recurred at 6 weeks. Based on these findings, GMA could be an effective therapy for refractory PPP.

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Combination Therapy of Infliximab and Granulocyte/Monocyte Adsorption Apheresis for Refractory Pustular Psoriasis with Psoriatic Arthritis

Cited by 13 publications

References 9 publications

Number of circulating non-classical (CD14+CD16++) monocytes negatively correlates with DAS28 and swollen joints count in peripheral spondyloarthritis patients

Number of circulating non-classical (CD14+CD16++) monocytes negatively correlates with DAS28 and swollen joints count in peripheral spondyloarthritis patients

Successful treatment of pyoderma gangrenosum with granulocyte and monocyte adsorption apheresis

Efficacy of Granulocyte and Monocyte Adsorption Apheresis for Treatment of Palmoplantar Pustulosis

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