Psoriatic Arthritis

Forty subjects with psoriatic arthritis (PA) underwent H L A tissue typing. H L A W27 was significantly increased in psoriatic spondylitis (350/,), whereas statistical significance was not reached in patients with peripheral arthritis alone, although W27 was present in a frequency greater than in controls. Psoriatic spondylitis (often asymptomatic) occurred in 57% (23 of 40) of our PA patients. Of interest, psoriatic spondylitis was more often W27 negative than W27 positive; nevertheless, W27-positive and W27-negative spondylitis was clinically and radiographically indistinguishable except that W27-positive disease occurred exclusively in males and the duration of the psoriasis was shorter when compared to W27-negative spondylitis.Psoriatic arthritis (PA) is generally considered a distinct disease entity based upon epidemiologic, clinical, laboratory, and radiographic criteria (1,2). This arthropathy occurs in about 5% of patients with psoriasis and is characterized by a seronegative, oligo-, or polyarthritis with or without axial skeletal involvement (ie sacroiliitis and/or spondylitis) (1).Recently, a striking association between histocompatibility antigen (HL-A) WZ7 and the "rheumatoid" variants of idiopathic ankylosing spondylitis (AS), Reiter's syndrome (RS), and the spondylitis occurring with inflammatory bowel disease (IBD), and PA has been documented (3-8). These diseases are similar to PA by virtue of their seronegativity and type of axial skeletal involvement. Accordingly we have also studied patients with PA to determine the incidence of W27 positivity. Our findings indicate that the frequency of W27 is significantly increased in PA complicated by spondylitis. The incidence of this antigen was increased in subjects without spinal disease but did not reach statistical significance. Furthermore, in sharp contrast to other rheumatoid variant disorders, psoriatic spondylitis is more often W27 negative than positive; other investigators, on the contrary, noted psoriatic spondylitis to generally be more often W27 positive (8).

Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

HL‐A W27 in psoriatic arthropathy

Metzger

Morris

Bluestone

et al. 1975

“…Yet, the formal clinical distinction between psoriatic arthritis (PsA) and rheumatoid arthritis (RA) was only made in 1961, and was based on a composition of clinical features, including asymmetric pauciarticular arthritis involving the distal interphalangeal joints and dactylitis in the absence of rheumatoid factor (1). Currently, the diagnosis of PsA remains difficult due to the absence of specific markers and is therefore still mainly determined by clinical signs and symptoms (2).…”

mentioning

confidence: 99%

Alefacept treatment in psoriatic arthritis: Reduction of the effector T cell population in peripheral blood and synovial tissue is associated with improvement of clinical signs of arthritis

Kraan

Kuijk

Dinant

et al. 2002

135

Objective. To investigate whether alefacept (a fully human lymphocyte function-associated antigen 3 [LFA-3]/IgG1 fusion protein that blocks the LFA-3/CD2 interaction) is able to reduce the signs and symptoms of joint inflammation in patients with active psoriatic arthritis (PsA).Methods. Eleven patients with active PsA were treated with alefacept for 12 weeks in an open-label and explorative study. Clinical joint assessment and laboratory assessments were performed at baseline and after 4, 9, 12, and 16 weeks of treatment. Serial synovial tissue (ST) biopsy specimens from an inflamed index joint (knee, ankle, wrist, or metacarpophalangeal joint) were obtained by arthroscopy at baseline and after 4 and 12 weeks of treatment.Results. At the completion of treatment, 6 of 11 patients (55%) fulfilled the Disease Activity Score (DAS) response criteria. Nine patients (82%) fulfilled the DAS response criteria at any point during the study. There was a statistically significant reduction in CD4؉ lymphocytes (P < 0.05), CD8؉ lymphocytes (P ‫؍‬ 0.05), and CD68؉ macrophages (P < 0.02) in the ST after 12 weeks of treatment compared with baseline. The ST and peripheral blood of those patients fulfilling the DAS response criteria contained more CD45RO؉ cells at baseline and displayed a significant reduction in these cells compared with nonresponding patients.Conclusion. The changes in ST, together with the improvement in clinical joint scores, after treatment with alefacept support the hypothesis that T cell activation plays an important role in this chronic inflammatory disease. Furthermore, since alefacept, a T cellspecific agent, led to decreased macrophage infiltration, the data indicate that T cells are highly involved in synovial inflammation in PsA.

“…The criteria for the diagnosis of psoriatic arthritis as differentiated from psoriasis and arthritis are those of Wright and Moll (15). They describe three major clinical groups of (1 Moderate, gradual improvement over a period of several months.…”

Section: Materials and Methods Patientsmentioning

confidence: 99%

“…Eleven of these had psoriatic arthritis and the other 2 had psoriasis with an arthritis indistinguishable from rheumatoid arthritis (15).…”

mentioning

confidence: 99%

Treatment of psoriatic arthritis with 6‐mercaptopurine

Baum

Hurd

Lewis

et al. 1973

Thirteen patients with psoriasis and arthritis were treated with 6-mercaptopurine in dosages ranging from 20 to 150 mg/day (0.36 to 2.4 mg/kg/ day). Eleven of the 13 patients with a diagnosis of psoriatic arthritis showed improvement of the arthritis and psoriasis with minimal side effects. Improvement could be maintained on a dose of about 1.0 mg/kg/ day. The improvement was seen in 3 weeks or less in most cases. Remission after stopping therapy lasted up to 10 months.The use of antimetabolic agents for the treatment of psoriasis is well known. The purine analog, 6-mercaptopurine (6-MP), the pyrimidine analog 6-azauridine triacetate (Azaribine) and the folate antagonist methotrexate, are perhaps the best known agents. Beneficial ef-