Marked increase in the frequency of psoriatic arthritis in psoriasis patients with hla–dr+ keratinocytes

Abstract

Immunocytochemical studies with a monoclonal anti–HLA–DR antibody were performed on skin sections and keratinocyte (KTC) suspensions obtained from suction blisters of active psoriatic plaques. HLA–DR+ KTCs were found in the plaques of 23 of 38 patients with active psoriasis. Of these 23, 16 had clinical findings typical of psoriatic arthritis (PA); none of the 15 patients who lacked HLA–DR+ KTCs had PA. Although KTC HLA–DR expression was more prevalent in patients with severe skin disease, 7 of the 23 patients with HLA–DR + KTCs in active psoriatic plaques had mild skin disease; 4 of these 7 had PA. Nail pitting or duration of skin disease did not account for increased incidence of PA in patients with HLA–DR+ KTCs. All psoriasis patients with arthritis received nonsteroidal antiinflammatory drug therapy; 14 received additional therapy directed primarily to the cutaneous manifestations of psoriasis. Nine of these noted arthritis improvement with concurrent skin response; however, in 5 patients, arthritis activity increased, despite improvement of the cutaneous disease. Two other patients, treated with methotrexate, also had concurrent skin and joint improvement. These data suggest that psoriasis patients with HLA–DR + KTCs are at increased risk for the development of associated arthritis.

Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies

“…Stratified by year of publication, there were 13 studies [21,[42][43][44][45][46][47][48][49][50][51][52][53] from pre-2000, resulting in a pooled prevalence estimate of 22.0% (16.1%-28.5%).…”

Detection of inflammatory cytokines in psoriatic skin

“…Interestingly, three of the four patients with IL-1 [3 in involved skin complained of arthralgia. An increased incidence of psoritic arthritis has been reported associated with the expression of HLA-DR antigens on keratinocytes [27], and the involvement of IL-I[3 in the development of rheumatoid synovitis has been reported by us [28]. A relationship between the existence of nonfunctional IL-1 [3 in the skin and the incidence of arthritis was indicated by this study.…”

RT‐PCR Topography of Chronic Psoriasis Skin Based on Analysis of T‐Cell Receptor B Variable Region Gene Usage

“…Activated T lymphocytes are thought to be involved in the development of psoriasis [8]. It is likely that at least some of these cells are activated locally in psoriatic skin in contact with basal cells and keratinocytes MHC class II expressing cells [17]. It is also plausible that T cells of particular importance for the pathogenesis of the disease are restricted by particular MHC class I and II.…”