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Bonfiglioli KR, Lopes FODA, de Figueiredo LQ, Ferrari LFF, Guedes L. Ultrasonographic Insights into Peripheral Psoriatic Arthritis: Updates in Diagnosis and Monitoring. J Pers Med 2024; 14:550. [PMID: 38929771 PMCID: PMC11205202 DOI: 10.3390/jpm14060550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Reumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil; (F.O.d.A.L.); (L.Q.d.F.); (L.F.F.F.); (L.G.)
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2
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Liu N, Dong J, Li L, Zhou D, Liu F. The Function and Mechanism of Anti-Inflammatory Factor Metrnl Prevents the Progression of Inflammatory-Mediated Pathological Bone Osteolytic Diseases. J Inflamm Res 2024; 17:1607-1619. [PMID: 38495340 PMCID: PMC10942011 DOI: 10.2147/jir.s455790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024] Open
Abstract
Metrnl, recently identified as an adipokine, is a secreted protein notably expressed in white adipose tissue, barrier tissues, and activated macrophages. This adipokine plays a pivotal role in counteracting obesity-induced insulin resistance. It enhances adipose tissue functionality by promoting adipocyte differentiation, activating metabolic pathways, and exerting anti-inflammatory effects. Extensive research has identified Metrnl as a key player in modulating inflammatory responses and as an integral regulator of muscle regeneration. These findings position Metrnl as a promising biomarker and potential therapeutic target in treating inflammation-associated pathologies. Despite this, the specific anti-inflammatory mechanisms of Metrnl in immune-mediated osteolysis and arthritis remain elusive, warranting further investigation. In this review, we will briefly elaborate on the role of Metrnl in anti-inflammation function in inflammation-related osteolysis, arthritis, and pathological bone resorption, which could facilitate Metrnl's clinical application as a novel therapeutic strategy to prevent bone loss. While the pathogenesis of elbow stiffness remains elusive, current literature suggests that Metrnl likely exerts a pivotal role in its development.
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Affiliation(s)
- Nan Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Jinlei Dong
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Lianxin Li
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Dongsheng Zhou
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
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Nazri JM, Oikonomopoulou K, de Araujo ED, Kraskouskaya D, Gunning PT, Chandran V. Histone deacetylase inhibitors as a potential new treatment for psoriatic disease and other inflammatory conditions. Crit Rev Clin Lab Sci 2023; 60:300-320. [PMID: 36846924 DOI: 10.1080/10408363.2023.2177251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Collectively known as psoriatic disease, psoriasis and psoriatic arthritis (PsA) are immune-mediated inflammatory diseases in which patients present with cutaneous and musculoskeletal inflammation. Affecting roughly 2-3% of the world's total population, there remains unmet therapeutic needs in both psoriasis and PsA despite the availability of current immunomodulatory treatments. As a result, patients with psoriatic disease often experience reduced quality of life. Recently, a class of small molecules, commonly investigated as anti-cancer agents, called histone deacetylase (HDAC) inhibitors, have been proposed as a new promising anti-inflammatory treatment for immune- and inflammatory-related diseases. In inflammatory diseases, current evidence is derived from studies on diseases like rheumatoid arthritis (RA) and systematic lupus erythematosus (SLE), and while there are some reports studying psoriasis, data on PsA patients are not yet available. In this review, we provide a brief overview of psoriatic disease, psoriasis, and PsA, as well as HDACs, and discuss the rationale behind the potential use of HDAC inhibitors in the management of persistent inflammation to suggest its possible use in psoriatic disease.
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Affiliation(s)
- Jehan Mohammad Nazri
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | | | - Elvin D de Araujo
- Department of Chemical and Physical Sciences, University of Toronto, Mississauga, Canada
| | - Dziyana Kraskouskaya
- Department of Chemical and Physical Sciences, University of Toronto, Mississauga, Canada
| | - Patrick T Gunning
- Department of Chemical and Physical Sciences, University of Toronto, Mississauga, Canada.,Department of Chemistry, University of Toronto, Toronto, Canada
| | - Vinod Chandran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Schroeder Arthritis Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Medicine, Memorial University, St. John's, Canada
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4
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Reveille JD, Ridley LK. Spondyloarthritis. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Galozzi P, Oliviero F, Scanu A, Lorenzin M, Ortolan A, Favero M, Doria A, Ramonda R. Acute joint swelling in psoriatic arthritis: Flare or "psout"-A 10-year-monocentric study on synovial fluid. Exp Biol Med (Maywood) 2022; 247:1650-1656. [PMID: 35876168 PMCID: PMC9597207 DOI: 10.1177/15353702221110666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a multifaceted inflammatory disease associated with psoriasis that can affect peripheral joints, entheses, and the axial skeleton with a variable clinical course. Acute episodes of joint swelling in PsA patients can have different causes and require specific treatments. We aimed to describe the acute joint swelling in PsA patients via synovial fluid (SF) analyses, assessing in particular the presence of pathogenic crystals, to determine whether it is a flare or an acute episode of gout ("psout") during the course of the disease. This retrospective study was based on the results of SF analysis of samples collected from unselected adult PsA patients referred to our clinic for acute joint swelling. Demographic characteristics, disease involvement, laboratory findings on SF, and treatment options were recorded and reviewed. Among 5,478 SF samples analyzed in a 10-year time span, 213 complete SF records from PsA patients were evaluated. Overall, after adjustment for the degree of synovial inflammation, significant differences were observed in term of sex (p = 0.0017) and ongoing therapy (p = 0.0246). Non-inflammatory SFs, indeed, were mainly described for female PsA patients under therapy. Regarding serum uric acid levels, there were 19/213 (8.9%) PsA with hyperuricemia (HU), who were older, mostly male, patients with mild articular involvement and rare pathogenic crystals in their SF. Although it is known that the risk of gout is higher among patients with PsA ("psout"), monosodium urate crystals were reported only in 5/213 SFs (2.4%) of our cohort and in 2/19 SFs (10.5%) of HU PsA patients. Moreover, hyperuricemia seems not to modify the SF features in PsA patients. This study results seem to suggest that the convergence of gout and PsA, involving the role of urate crystals, is a more intricate relationship, which needs further insights to be unraveled.
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Affiliation(s)
- Paola Galozzi
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Medicina Interna I, Ca’ Foncello
Hospital, 31100 Treviso, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of
Medicine DIMED, University of Padova, 35128 Padova, Italy,Roberta Ramonda.
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Tenazinha C, Barros R, Fonseca JE, Vieira-Sousa E. Histopathology of Psoriatic Arthritis Synovium—A Narrative Review. Front Med (Lausanne) 2022; 9:860813. [PMID: 35847785 PMCID: PMC9283901 DOI: 10.3389/fmed.2022.860813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a phenotypically heterogeneous chronic inflammatory disease associated to type I major histocompatibility complex alleles whose complex pathogenesis is still not completely understood. The psoriatic synovium shares general features of chronic inflammation with rheumatoid arthritis (RA) and other arthritis, such as hyperplasia of the intimal lining layer, sublining influx of inflammatory cells and neoangiogenesis, but recognizing disease-specific histopathologic findings may help in diagnosis and definition of therapeutic targets. Available literature reports conflicting data regarding the extension of lining hyperplasia, that does not allow depiction from RA. Sublining inflammatory cells consist of T and B cells and macrophages, plasma cells, mast cells and follicular dendritic cells, with a higher amount of overall T, mast cell and IL-17 producing CD8+ T lymphocytes and lower proportion of plasma cells when compared to the rheumatoid synovium. The amount of synovium IL17+ CD8+ T cells correlates positively to measures of disease activity. Lymphoid follicles with characteristics of germinal centers have been identified, similar to the ones described in RA. Neoangiogenesis is more prominent in PsA but can also be an outstanding feature in some RA samples, and different molecules involved in the process appear to have different influence in each disease. IL-17 and IL-22 expression in the synovium does not allow depiction between diseases. Among other cytokines and molecules likely implicated in disease physiopathology, only IL-35 is demonstrated to be reduced in PsA when compared to RA.
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Affiliation(s)
- Catarina Tenazinha
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Catarina Tenazinha,
| | - Rita Barros
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
| | - João Eurico Fonseca
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Department of Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria, Centro Hospitalar Universitàrio de Lisboa-Norte, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon Academic Medical Center, Universidade de Lisboa, Lisbon, Portugal
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Floudas A, Gorman A, Neto N, Monaghan MG, Elliott Z, Fearon U, Marzaioli V. Inside the Joint of Inflammatory Arthritis Patients: Handling and Processing of Synovial Tissue Biopsies for High Throughput Analysis. Front Med (Lausanne) 2022; 9:830998. [PMID: 35372383 PMCID: PMC8967180 DOI: 10.3389/fmed.2022.830998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Inflammatory arthritis is a chronic systemic autoimmune disease of unknown etiology, which affects the joints. If untreated, these diseases can have a detrimental effect on the patient's quality of life, leading to disabilities, and therefore, exhibit a significant socioeconomic impact and burden. While studies of immune cell populations in arthritis patient's peripheral blood have been informative regarding potential immune cell dysfunction and possible patient stratification, there are considerable limitations in identifying the early events that lead to synovial inflammation. The joint, as the site of inflammation and the local microenvironment, exhibit unique characteristics that contribute to disease pathogenesis. Understanding the contribution of immune and stromal cell interactions within the inflamed joint has been met with several technical challenges. Additionally, the limited availability of synovial tissue biopsies is a key incentive for the utilization of high-throughput techniques in order to maximize information gain. This review aims to provide an overview of key methods and novel techniques that are used in the handling, processing and analysis of synovial tissue biopsies and the potential synergy between these techniques. Herein, we describe the utilization of high dimensionality flow cytometric analysis, single cell RNA sequencing, ex vivo functional assays and non-intrusive metabolic characterization of synovial cells on a single cell level based on fluorescent lifetime imaging microscopy. Additionally, we recommend important points of consideration regarding the effect of different storage and handling techniques on downstream analysis of synovial tissue samples. The introduction of new powerful techniques in the study of synovial tissue inflammation, brings new challenges but importantly, significant opportunities. Implementation of novel approaches will accelerate our path toward understanding of the mechanisms involved in the pathogenesis of inflammatory arthritis and lead to the identification of new avenues of therapeutic intervention.
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Affiliation(s)
- Achilleas Floudas
- Molecular Rheumatology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- European League Against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St. Vincent's University Hospital, University College Dublin (UCD), Dublin, Ireland
- *Correspondence: Achilleas Floudas
| | - Aine Gorman
- European League Against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St. Vincent's University Hospital, University College Dublin (UCD), Dublin, Ireland
| | - Nuno Neto
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Michael G. Monaghan
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Zoe Elliott
- European League Against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St. Vincent's University Hospital, University College Dublin (UCD), Dublin, Ireland
| | - Ursula Fearon
- Molecular Rheumatology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- European League Against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St. Vincent's University Hospital, University College Dublin (UCD), Dublin, Ireland
| | - Viviana Marzaioli
- Molecular Rheumatology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- European League Against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St. Vincent's University Hospital, University College Dublin (UCD), Dublin, Ireland
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Marzaioli V, Canavan M, Floudas A, Flynn K, Mullan R, Veale DJ, Fearon U. CD209/CD14 + Dendritic Cells Characterization in Rheumatoid and Psoriatic Arthritis Patients: Activation, Synovial Infiltration, and Therapeutic Targeting. Front Immunol 2022; 12:722349. [PMID: 35095831 PMCID: PMC8789658 DOI: 10.3389/fimmu.2021.722349] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022] Open
Abstract
Dendritic cells (DC) have a key role in the initiation and progression of inflammatory arthritis (IA). In this study, we identified a DC population that derive from monocytes, characterized as CD209/CD14+ DC, expressing classical DC markers (HLADR, CD11c) and the Mo-DC marker (CD209), while also retaining the monocytic marker CD14. This CD209/CD14+ DC population is present in the circulation of Healthy Control (HC), with increased frequency in Rheumatoid Arthritis (RA) and Psoriatic arthritic (PsA) patients. We demonstrate, for the first time, that circulatory IA CD209/CD14+ DC express more cytokines (IL1β/IL6/IL12/TNFα) and display a unique chemokine receptor expression and co-expression profiles compared to HC. We demonstrated that CD209/CD14+ DC are enriched in the inflamed joint where they display a unique inflammatory and maturation phenotype, with increased CD40 and CD80 and co-expression of specific chemokine receptors, displaying unique patterns between PsA and RA. We developed a new protocol of magnetic isolation and expansion for CD209+ DC from blood and identified transcriptional differences involved in endocytosis/antigen presentation between RA and PsA CD209+ DC. In addition, we observed that culture of healthy CD209+ DC with IA synovial fluid (SF), but not Osteoarthritis (OA) SF, was sufficient to induce the development of CD209/CD14+ DC, leading to a poly-mature DC phenotype. In addition, differential effects were observed in terms of chemokine receptor and chemokine expression, with healthy CD209+ DC displaying increased expression/co-expression of CCR6, CCR7, CXCR3, CXCR4 and CXCR5 when cultured with RA SF, while an increase in the chemokines CCR3, CXCL10 and CXCL11 was observed when cultured with PsA SF. This effect may be mediated in part by the observed differential increase in chemokines expressed in RA vs PsA SF. Finally, we observed that the JAK/STAT pathway, but not the NF-κB pathway (driven by TNFα), regulated CD209/CD14+ DC function in terms of activation, inflammatory state, and migratory capacity. In conclusion, we identified a novel CD209/CD14+ DC population, which is active in the circulation of RA and PsA, an effect potentiated once they enter the joint. Furthermore, we demonstrated that JAK/STAT inhibition can be used as a therapeutic strategy to decrease the inflammatory state of the pathogenic CD209/CD14+ DC.
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Affiliation(s)
- Viviana Marzaioli
- Rheumatology EULAR Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mary Canavan
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Achilleas Floudas
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Keelin Flynn
- Rheumatology EULAR Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Ronan Mullan
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Douglas J Veale
- Rheumatology EULAR Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Ursula Fearon
- Rheumatology EULAR Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Qi F, Tan Y, Yao A, Yang X, He Y. Psoriasis to Psoriatic Arthritis: The Application of Proteomics Technologies. Front Med (Lausanne) 2021; 8:681172. [PMID: 34869404 PMCID: PMC8635007 DOI: 10.3389/fmed.2021.681172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Psoriatic disease (PsD) is a spectrum of diseases that affect both skin [cutaneous psoriasis (PsC)] and musculoskeletal features [psoriatic arthritis (PsA)]. A considerable number of patients with PsC have asymptomatic synovio-entheseal inflammations, and approximately one-third of those eventually progress to PsA with an enigmatic mechanism. Published studies have shown that early interventions to the very early-stage PsA would effectively prevent substantial bone destructions or deformities, suggesting an unmet goal for exploring early PsA biomarkers. The emergence of proteomics technologies brings a complete view of all involved proteins in PsA transitions, offers a unique chance to map all potential peptides, and allows a direct head-to-head comparison of interaction pathways in PsC and PsA. This review summarized the latest development of proteomics technologies, highlighted its application in PsA biomarker discovery, and discussed the possible clinical detectable PsA risk factors in patients with PsC.
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Affiliation(s)
- Fei Qi
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Yaqi Tan
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Amin Yao
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Xutong Yang
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Yanling He
- Department of Dermatology, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
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10
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Importance of lymphocyte-stromal cell interactions in autoimmune and inflammatory rheumatic diseases. Nat Rev Rheumatol 2021; 17:550-564. [PMID: 34345021 DOI: 10.1038/s41584-021-00665-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
Abstract
Interactions between lymphocytes and stromal cells have an important role in immune cell development and responses. During inflammation, stromal cells contribute to inflammation, from induction to chronicity or resolution, through direct cell interactions and through the secretion of pro-inflammatory and anti-inflammatory mediators. Stromal cells are imprinted with tissue-specific phenotypes and contribute to site-specific lymphocyte recruitment. During chronic inflammation, the modified pro-inflammatory microenvironment leads to changes in the stromal cells, which acquire a pathogenic phenotype. At the site of inflammation, infiltrating B cells and T cells interact with stromal cells. These interactions induce a plasma cell-like phenotype in B cells and T cells, associated with secretion of immunoglobulins and inflammatory cytokines, respectively. B cells and T cells also influence the stromal cells, inducing cell proliferation, molecular changes and cytokine production. This positive feedback loop contributes to disease chronicity. This Review describes the importance of these cell interactions in chronic inflammation, with a focus on human disease, using three selected autoimmune and inflammatory diseases: rheumatoid arthritis, psoriatic arthritis (and psoriasis) and systemic lupus erythematosus. Understanding the importance and disease specificity of these interactions could provide new therapeutic options.
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O'Brien A, Hanlon MM, Marzaioli V, Wade SC, Flynn K, Fearon U, Veale DJ. Targeting JAK-STAT Signalling Alters PsA Synovial Fibroblast Pro-Inflammatory and Metabolic Function. Front Immunol 2021; 12:672461. [PMID: 34248953 PMCID: PMC8264423 DOI: 10.3389/fimmu.2021.672461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. Janus Kinase inhibitors (JAKi) have emerged as an encouraging class of drugs for the treatment of PsA. Here, we compare the effect of four JAKi on primary PsA synovial fibroblasts (PsAFLS) activation, metabolic function, and invasive and migratory capacity. Methods Primary PsAFLS were isolated and cultured with JAKi (Peficitinib, Filgotinib, Baricitinib and Upadacitinib) in the presence of Oncostatin M (OSM). pSTAT3 expression in response to OSM was quantified by Western Blot analysis. Pro-inflammatory cytokines/chemokines were quantified by ELISA and cell migration by wound-repair scratch assays. Invasive capacity was examined using Matrigel™ invasion chambers and MMP multiplex MSD assays. PsAFLS bioenergetics was assessed using the Seahorse XFe Extracellular Flux Analyzer, which simultaneously quantifies two energetic pathways- glycolysis (ECAR) and oxidative phosphorylation (OCR). In parallel, inflammatory, invasive, and migratory genes were quantified by RT-PCR. Results OSM induces pSTAT3 expression in PsAFLS. OSM-induced secretion of MCP-1 and IL-6 was inhibited by all JAKi with Peficitinib, Baricitinib and Upadacitinib showing the greatest effect. In contrast, JAKi had no significant impact on IL-8 expression in response to OSM. PsAFLS cell invasion, migratory capacity and MMP1, 3, and 9 were suppressed following JAKi treatment, with Peficitinib showing the greatest effect. These functional effects were accompanied by a change in the cellular bioenergetic profile of PsAFLS, where JAKi significantly decreased glycolysis and the ECAR/OCR, resulting in a shift to a more quiescent phenotype, with Peficitinib demonstrating the most pronounced effect. Conclusion This study demonstrates that JAK/STAT signalling mediates the complex interplay between inflammation and cellular metabolism in PsA pathogenesis. This inhibition shows effective suppression of inflammatory mechanisms that drive pathogenic functions of PsAFLS, further supporting the role of JAKi as a therapeutic target for the treatment of PsA.
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Affiliation(s)
- Aisling O'Brien
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Megan Mary Hanlon
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Viviana Marzaioli
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Siobhan C Wade
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Keelin Flynn
- Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Ursula Fearon
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Douglas J Veale
- Rheumatology European League against Rheumatism (EULAR) Centre of Excellence, Centre for Arthritis & Rheumatic Diseases, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
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Silvagni E, Missiroli S, Perrone M, Patergnani S, Boncompagni C, Bortoluzzi A, Govoni M, Giorgi C, Alivernini S, Pinton P, Scirè CA. From Bed to Bench and Back: TNF-α, IL-23/IL-17A, and JAK-Dependent Inflammation in the Pathogenesis of Psoriatic Synovitis. Front Pharmacol 2021; 12:672515. [PMID: 34211394 PMCID: PMC8241099 DOI: 10.3389/fphar.2021.672515] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory immune-mediated disease with a burdensome impact on quality of life and substantial healthcare costs. To date, pharmacological interventions with different mechanisms of action, including conventional synthetic (cs), biological (b), and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs), have been proven efficacious, despite a relevant proportion of failures. The current approach in clinical practice and research is typically "predictive": the expected response is based on stratification according to clinical, imaging, and laboratory data, with a "heuristic" approach based on "trial and error". Several available therapeutic options target the TNF-α pathway, while others are directed against the IL-23/IL-17A axis. Janus kinase inhibitors (JAKis), instead, simultaneously block different pathways, endowing these drugs with a potentially "broad-spectrum" mechanism of action. It is not clear, however, whether targeting a specific pathway (e.g., TNF-α or the IL-23/IL-17 axis) could result in discordant effects over other approaches. In particular, in the case of "refractory to a treatment" patients, other pathways might be hyperactivated, with opposing, synergistic, or redundant biological significance. On the contrary, refractory states could be purely resistant to treatment as a whole. Since chronic synovitis is one of the primary targets of inflammation in PsA, synovial biomarkers could be useful in depicting specific biological characteristics of the inflammatory burden at the single-patient level, and despite not yet being implemented in clinical practice, these biomarkers might help in selecting the proper treatment. In this narrative review, we will provide an up-to-date overview of the knowledge in the field of psoriatic synovitis regarding studies investigating the relationships among different activated proinflammatory processes suitable for targeting by different available drugs. The final objective is to clarify the state of the art in the field of personalized medicine for psoriatic disease, aiming at moving beyond the current treatment schedules toward a patient-centered approach.
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Affiliation(s)
- Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - Sonia Missiroli
- Department of Medical Sciences, Section of Experimental Medicine, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Mariasole Perrone
- Department of Medical Sciences, Section of Experimental Medicine, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Simone Patergnani
- Department of Medical Sciences, Section of Experimental Medicine, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Caterina Boncompagni
- Department of Medical Sciences, Section of Experimental Medicine, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - Carlotta Giorgi
- Department of Medical Sciences, Section of Experimental Medicine, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Stefano Alivernini
- Rheumatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Pinton
- Department of Medical Sciences, Section of Experimental Medicine, Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
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Wade SM, Canavan M, McGarry T, Low C, Wade SC, Mullan RH, Veale DJ, Fearon U. Association of synovial tissue polyfunctional T-cells with DAPSA in psoriatic arthritis. Ann Rheum Dis 2019; 78:350-354. [PMID: 30626658 PMCID: PMC6390025 DOI: 10.1136/annrheumdis-2018-214138] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/29/2018] [Accepted: 12/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study examines polyfunctional T-cells in psoriatic arthritis (PsA) synovial tissue and their associations with clinical disease and implications for therapy. METHODS PsA synovial tissue was enzymatically/mechanically digested to generate synovial tissue single cell suspensions. Frequencies of polyfunctional CD4, CD8, T-helper 1 (Th1), Th17 and exTh17 cells, using CD161 as a marker of Th17 plasticity, were determined by flow cytometry in matched PsA synovial tissue and peripheral blood. Synovial T-cell polyfunctionality was assessed in relation to Disease Activity in PSoriatic Arthritis (DAPSA) and in synovial cell suspensions cultured with a current mode of treatment, phosphodiesterase 4 (PDE4) inhibitor. RESULTS PsA synovial tissue infiltrating CD4+ T-cells expressed higher levels of interleukin (IL)-17A, interferon gamma (IFN-γ), GM-CSF and CD161, with parallel enrichment of Th1, Th17 and exTh17 T-helper subsets (all p<0.05). Interestingly, a significant proportion of synovial T-cell subsets were triple-positive for GM-CSF, tumour necrosis factor (-TNF), -IL-17 or IFN-γ compared with matched blood (all p<0.05). Importantly, frequencies of polyfunctional T-cells correlated with DAPSA: Th1-GM-CSF+/TNF+/IFN-γ+ (r=0.7, p<0.01), Th17-GM-CSF+/TNF+/IL-17+ (r=0.6, p<0.057) and exTh17-GM-CSF+/TNF+/IFN-γ+ (r=0.7, p=0.0096), with no associations observed for single cytokine-producing T-cells. Following ex vivo culture of PsA synovial tissue cell suspensions, polyfunctional GM-CSF+TNFα+IL-17A+ or/IFN-γ+-producing T-cells (p<0.05), but not single cytokine-producing T-cells, were inhibited with a PDE4 inhibitor. CONCLUSION These data demonstrate enrichment of polyfunctional T-cells in PsA synovial tissue which were strongly associated with DAPSA and ex vivo therapeutic response.
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Affiliation(s)
- Sarah M Wade
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,St Vincent's University Hospital, Dublin Academic Health Care and University College Dublin, Dublin 4, Ireland
| | - Mary Canavan
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Trudy McGarry
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,St Vincent's University Hospital, Dublin Academic Health Care and University College Dublin, Dublin 4, Ireland
| | - Candice Low
- St Vincent's University Hospital, Dublin Academic Health Care and University College Dublin, Dublin 4, Ireland
| | - Siobhan C Wade
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Ronan H Mullan
- Department of Rheumatology, Tallaght University Hospital, Dublin 24, Ireland
| | - Douglas J Veale
- St Vincent's University Hospital, Dublin Academic Health Care and University College Dublin, Dublin 4, Ireland
| | - Ursula Fearon
- Molecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
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15
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Liu H, Wei SP, Zhi LQ, Liu LP, Cao TP, Wang SZ, Chen QP, Liu D. Synovial GATA1 mediates rheumatoid arthritis progression via transcriptional activation of NOS2
signaling. Microbiol Immunol 2018; 62:594-606. [PMID: 29993142 DOI: 10.1111/1348-0421.12637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Huan Liu
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
| | - Shu-Ping Wei
- Department of Preventive and Health Services; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
| | - Li-Qin Zhi
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
- Xi'an Institute of Rheumatology; Xi'an 710082 China
| | - Li-Ping Liu
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
- Xi'an Institute of Rheumatology; Xi'an 710082 China
| | - Tuan-Ping Cao
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
- Xi'an Institute of Rheumatology; Xi'an 710082 China
| | - Su-Zhi Wang
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
| | - Qing-Ping Chen
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
| | - Dan Liu
- Department of Rheumatology and Immunology; Xi'an No. 5 Hospital; 112 XiGuanZhengJie Lian Hu District Xi'an 710082 China
- Xi'an Institute of Rheumatology; Xi'an 710082 China
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Casciano F, Pigatto PD, Secchiero P, Gambari R, Reali E. T Cell Hierarchy in the Pathogenesis of Psoriasis and Associated Cardiovascular Comorbidities. Front Immunol 2018; 9:1390. [PMID: 29971067 PMCID: PMC6018171 DOI: 10.3389/fimmu.2018.01390] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
The key role of T cells in the pathogenesis of cutaneous psoriasis has been well described in the last decade and the knowledge of the relative role of the different subsets of T cells in psoriasis pathogenesis has considerably evolved. Now, it is clear that IL-17A-producing T cells, including Th17/Tc17, have a central role in the pathogenesis of cutaneous psoriasis and therapies blocking the IL-17A pathway show high clinical efficacy. By contrast, the contribution of IFNγ-producing T cells has progressively become less clear because of the lack of efficacy of anti-IFNγ antibodies in clinical studies. In parallel, the role of CD8+ T cells specific for self-antigens has been revived and increasing evidence now indicates that in psoriatic skin the majority CD8+ T cells are present in the form of epidermal tissue-resident memory T cells. In the last years it also emerged the possibility of a contribution of T cell recirculation in the pathogenesis of psoriasis and its systemic manifestations. The aim of this review is to define a hierarchy for the different subsets of T cells in the T cell-mediated inflammatory cascade in psoriatic skin. This analysis will possibly help to distinguish the subsets that initiate the disease, those involved in the establishment of the self-sustaining amplification loop that leads to the cutaneous clinical manifestations and finally the subsets that act as downstream players in established lesions. Specific T cell subpopulations finally will be considered for their possible role in propagating inflammation at distant sites and for representing a link with systemic inflammation and cardiovascular comorbidities.
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Affiliation(s)
- Fabio Casciano
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Paolo D Pigatto
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Gambari
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Eva Reali
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy.,Laboratory of Translational Immunology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
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Chimenti MS, Perricone C, Novelli L, Caso F, Costa L, Bogdanos D, Conigliaro P, Triggianese P, Ciccacci C, Borgiani P, Perricone R. Interaction between microbiome and host genetics in psoriatic arthritis. Autoimmun Rev 2018; 17:276-283. [DOI: 10.1016/j.autrev.2018.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 12/21/2022]
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18
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Patience A, Helliwell PS, Siddle HJ. Focussing on the foot in psoriatic arthritis: pathology and management options. Expert Rev Clin Immunol 2017; 14:21-28. [DOI: 10.1080/1744666x.2018.1413351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aimie Patience
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Philip S. Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Heidi J. Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
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Clinical Features of Psoriatic Arthritis: a Comprehensive Review of Unmet Clinical Needs. Clin Rev Allergy Immunol 2017; 55:271-294. [DOI: 10.1007/s12016-017-8630-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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20
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21
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Szentpetery A, Heffernan E, Gogarty M, Mellerick L, McCormack J, Haroon M, Elmamoun M, Gallagher P, Kelly G, Fabre A, Kirby B, FitzGerald O. Abatacept reduces synovial regulatory T-cell expression in patients with psoriatic arthritis. Arthritis Res Ther 2017; 19:158. [PMID: 28679449 PMCID: PMC5498994 DOI: 10.1186/s13075-017-1364-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 06/09/2017] [Indexed: 12/17/2022] Open
Abstract
Background The aim was to study changes in immunohistochemical expression markers of synovial and skin inflammation, clinical outcomes and magnetic resonance imaging (MRI) scores with abatacept treatment in patients with psoriatic arthritis (PsA). Methods Biological-treatment-naïve PsA patients with active disease including synovitis of a knee were enrolled in this single-centre, crossover study. Patients were randomised to receive intravenous abatacept 3 mg/kg of body weight or placebo infusion on day 1, 15 and 29; thereafter abatacept 10 mg/kg of body weight was administered every 28 days for 5 months. Clinical data were collected at each visit. Synovial biopsy of the involved knee was obtained at baseline and 2 and 6 months. MRI of the same knee and skin biopsy was performed prior to arthroscopy. Results Fifteen patients were recruited. Significant improvements in the joint-related measures were observed; 90% were European League Against Rheumatism criteria responders and 30% achieved psoriasis area severity index (PASI)50 at 6 months. Reduction in synovitis (P = 0.016) and vascularity (P = 0.039) macroscopic scores consistent with decrease in total MRI score (P = 0.016) were noticed. Abatacept decreased the immunohistological expression of FOXP3+ cells (P = 0.027), specifically the expression of CD4+FOXP3+ regulatory T cells (Tregs) (P = 0.008) in the synovium over 6 months. There was no significant clinical or immunohistological change in any of the skin measures. Conclusion This is the first study assessing synovial and psoriatic skin immunpathological changes following abatacept treatment in PsA. Reduction in Treg expression in the synovium but not in the psoriatic lesion suggests abnormal Treg function in PsA with differential suppressive capacity in the synovium compared to the lesional skin. The results of this study demonstrate that abatacept 10 mg/kg of body weight might be an effective treatment option for joint disease in patients with PsA. Trial registration Irish Health Products Regulatory Authority. Trial registration number: CT 900/489/1 – Abatacept (case number: 2077284, EudraCT Number: 2009-017525-19, Protocol number: 77777). Registered on 12 March 2010.
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Affiliation(s)
- Agnes Szentpetery
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eric Heffernan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | | | - Lisa Mellerick
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Janet McCormack
- Research Pathology, Immunohistochemistry Core Facility, UCD Conway Institute, UCD School of Medicine, Dublin, Ireland
| | - Muhammad Haroon
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Musaab Elmamoun
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Phil Gallagher
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Genevieve Kelly
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland.,Research Pathology, Immunohistochemistry Core Facility, UCD Conway Institute, UCD School of Medicine, Dublin, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Oliver FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland.
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22
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Najm A, Orr C, Heymann MF, Bart G, Veale DJ, Le Goff B. Success Rate and Utility of Ultrasound-guided Synovial Biopsies in Clinical Practice. J Rheumatol 2016; 43:2113-2119. [PMID: 27744399 DOI: 10.3899/jrheum.151441] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The utility of synovial biopsy in increasing our understanding of the pathogenesis of inflammatory arthropathies, as well as in evaluating treatments, is well established. Ultrasound (US) allows synovial assessment and therefore assists in biopsying synovial tissue in a safe and well-tolerated manner. This study's objectives were to (1) determine the rate of success in retrieving synovial tissue using US guidance, (2) describe the indications for US-guided synovial biopsies in the clinical setting, (3) determine how frequently the synovial biopsy can lead to a clear diagnosis, and (4) assess the quality of the synovial tissue obtained using this technique. METHODS Synovial biopsies of small and large joints were performed under US guidance between February 2007 and December 2014 using a semiautomatic core biopsy needle. The biopsy procedure was considered successful if synovial tissue was found at histological examination. RESULTS Seventy-four patients with undifferentiated arthritis underwent 76 synovial biopsies. The success rate in retrieving synovial tissue was 81.6% (62/76). One patient taking acetyl salicylic acid at 75 mg at the time of the biopsy presented with hemarthrosis 48 h after the procedure, which resolved following simple arthrocentesis. A definitive diagnosis was achieved in 16% of the patients where synovial tissue was sampled successfully. CONCLUSION US-guided synovial biopsies in clinical practice can be performed safely on patients with undifferentiated arthritis and with heterogeneous presentations. The rate of success in acquiring synovial tissue is high. The procedure usually retrieves quality tissue and leads to a definite diagnosis in a significant minority of patients.
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Affiliation(s)
- Aurélie Najm
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Carl Orr
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Marie-Françoise Heymann
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Géraldine Bart
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Douglas J Veale
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland.,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital
| | - Benoît Le Goff
- From the Department of Rheumatology, and Department of Pathology, Hôtel-Dieu Hospital, Nantes, France; University College Dublin Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland. .,A. Najm, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; C. Orr, MD, University College Dublin Department of Rheumatology, St. Vincent's Hospital; M.F. Heymann, MD, Department of Pathology, Hôtel-Dieu Hospital; G. Bart, MD, Resident, Department of Rheumatology, Hôtel-Dieu Hospital; D.J. Veale, MD, PhD, Professor, University College Dublin Department of Rheumatology, St. Vincent's Hospital; B. Le Goff, PhD, Assistant Professor, Department of Rheumatology, Hôtel-Dieu Hospital.
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Conigliaro P, Chimenti M, Triggianese P, Sunzini F, Novelli L, Perricone C, Perricone R. Autoantibodies in inflammatory arthritis. Autoimmun Rev 2016; 15:673-83. [DOI: 10.1016/j.autrev.2016.03.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/28/2016] [Indexed: 02/07/2023]
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24
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Auto-reactions, autoimmunity and psoriatic arthritis. Autoimmun Rev 2015; 14:1142-6. [DOI: 10.1016/j.autrev.2015.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/03/2015] [Indexed: 12/28/2022]
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25
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Mc Ardle A, Flatley B, Pennington SR, FitzGerald O. Early biomarkers of joint damage in rheumatoid and psoriatic arthritis. Arthritis Res Ther 2015; 17:141. [PMID: 26028339 PMCID: PMC4450469 DOI: 10.1186/s13075-015-0652-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate biomarkers in rheumatoid and psoriatic arthritis, evaluated the evidence for their potential as biomarkers of bone (joint) damage, and outlined how mass spectrometry-based targeted and multiplexed measurement of candidate biomarker proteins is likely to accelerate their clinical validation and the development of clinical diagnostic tests.
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Affiliation(s)
- Angela Mc Ardle
- Conway Institute of Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Brian Flatley
- Conway Institute of Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Stephen R Pennington
- Conway Institute of Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Oliver FitzGerald
- Conway Institute of Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland. .,Department of Rheumatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Verheul MK, Fearon U, Trouw LA, Veale DJ. Biomarkers for rheumatoid and psoriatic arthritis. Clin Immunol 2015; 161:2-10. [PMID: 25934385 DOI: 10.1016/j.clim.2015.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/21/2015] [Indexed: 01/20/2023]
Abstract
Rheumatic diseases, such as rheumatoid and psoriatic arthritis are systemic inflammatory conditions characterized by a chronic form of arthritis, often leading to irreversible joint damage. Early treatment for patients with rheumatic diseases is required to reduce or prevent joint injury. However, early diagnosis can be difficult and currently it is not possible to predict which individual patient will develop progressive erosive disease or who may benefit from a specific treatment according to their clinical features at presentation. Biomarkers are therefore required to enable earlier diagnosis and predict prognosis in both rheumatoid arthritis and psoriatic arthritis. In this review we will examine the evidence and current status of established and experimental biomarkers in rheumatoid and psoriatic arthritis for three important purposes; disease diagnosis, prognosis and prediction of response to therapy.
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Affiliation(s)
- M K Verheul
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - U Fearon
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, UCD, Dublin, Ireland
| | - L A Trouw
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - D J Veale
- Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, UCD, Dublin, Ireland.
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Butt AQ, McArdle A, Gibson DS, FitzGerald O, Pennington SR. Psoriatic Arthritis Under a Proteomic Spotlight: Application of Novel Technologies to Advance Diagnosis and Management. Curr Rheumatol Rep 2015; 17:35. [DOI: 10.1007/s11926-015-0509-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Conigliaro P, Triggianese P, Perricone C, Chimenti MS, Di Muzio G, Ballanti E, Guarino MD, Kroegler B, Gigliucci G, Grelli S, Perricone R. Restoration of peripheral blood natural killer and B cell levels in patients affected by rheumatoid and psoriatic arthritis during etanercept treatment. Clin Exp Immunol 2014; 177:234-43. [PMID: 24666401 DOI: 10.1111/cei.12335] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 12/01/2022] Open
Abstract
Etanercept (ETN) is an anti-tumour necrosis factor (TNF)-α agent used in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Few studies focused on the effects of anti-TNF-α on peripheral blood cells. We aimed to evaluate peripheral blood cells in RA and PsA patients during ETN treatment and to explore their relationships with disease activity. RA (n = 82) and PsA (n = 32) patients who started ETN were included into the study and evaluated prospectively before the beginning of ETN therapy and after 14, 22, 54 and 102 weeks. Patients were studied in terms of disease activity score on 28 joints (DAS28), clinical response and laboratory findings. Natural killer (NK) cells, B cells and T cells were characterized by immunophenotyping. Both the RA and the PsA patients showed reduced NK and B cell count before ETN treatment compared with controls. A negative correlation was demonstrated between DAS28 and B cell count in RA patients at baseline. Sustained significant increase of NK and B cells up to normal levels was observed in RA and PsA patients along ETN treatment. Increase of NK cell count was associated with a good-moderate clinical response to ETN in both RA and PsA patients. During ETN treatment peripheral blood NK and B cells levels were restored in RA and PsA patients. Correlations between NK and B cells with disease activity were observed, suggesting that those effects could be mediated by ETN treatment.
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Affiliation(s)
- P Conigliaro
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
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Sheane BJ, Chandran V. Investigational drugs for treating psoriatic arthritis. Expert Opin Investig Drugs 2014; 23:1001-16. [DOI: 10.1517/13543784.2014.910194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Barry J Sheane
- University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital,
1E 416, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada ;
- University of Toronto, Department of Medicine, Division of Rheumatology,
Toronto, Canada
| | - Vinod Chandran
- University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital,
1E 416, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada ;
- University of Toronto, Department of Medicine, Division of Rheumatology,
Toronto, Canada
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Clinical and Contrast-Enhanced Ultrasound Echography Outcomes in Psoriatic Arthritis Patients after One Year of Continuous Therapy with Anti-TNF Drugs. ISRN DERMATOLOGY 2014; 2014:932721. [PMID: 24653837 PMCID: PMC3933554 DOI: 10.1155/2014/932721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/22/2013] [Indexed: 01/29/2023]
Abstract
Background. We wanted to verify retrospectively the proportion of patients with psoriatic arthritis who were in remission after 1 year of continuous therapy with either etanercept or adalimumab. Remission was defined as the absence of both clinical and contrast-enhanced ultrasound (CEUS) findings suggestive of joint inflammation. Patients and Methods. The data of twenty-five patients with psoriatic arthritis were available for the clinical and CEUS evaluations before and after 1 year of continuous therapy with etanercept or adalimumab. The count of swollen (ACR66), tender (ACR68), and active inflamed joints (AJC) was used to measure the severity of joint involvement. PASI was used to score the severity of psoriasis. HAQ, DLQI, VAS pain, and VAS itching were administered to each patient before starting therapy and every 3 months, up to 1 year. Results. Eight (32%) out of twenty-five patients were in remission after 1 year of therapy with etanercept or adalimumab. A significant reduction of all clinical variables analysed was seen during the course of therapy. Conclusion. Although a significant proportion of patients achieved remission of arthritis after 1 year of effective anti-TNF therapy, the majority of them continued to have either clinical or CEUS findings suggestive of persistence of joint inflammation.
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Bosè F, Capsoni F, Molteni S, Raeli L, Diani M, Altomare A, Garavaglia M, Garutti C, Frigerio E, Banfi G, Altomare G, Reali E. Differential expression of interleukin-2 by anti-CD3-stimulated peripheral blood mononuclear cells in patients with psoriatic arthritis and patients with cutaneous psoriasis. Clin Exp Dermatol 2013; 39:385-90. [DOI: 10.1111/ced.12251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F. Bosè
- Laboratory of Translational Immunology; IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - F. Capsoni
- Rheumatology Unit; IRCCS Istituto Ortopedico Galeazzi; Milan Italy
- University of Milan; Milan Italy
| | - S. Molteni
- Laboratory of Translational Immunology; IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - L. Raeli
- Department of Immunology; INGM-National Institute of Molecular Genetics; Milan Italy
| | - M. Diani
- Dermatology Unit; IRCCS Istituto Ortopedico Galeazzi Milan; Milan Italy
| | - A. Altomare
- Dermatology Unit; IRCCS Istituto Ortopedico Galeazzi Milan; Milan Italy
| | - M. Garavaglia
- Dermatology Unit; IRCCS Istituto Ortopedico Galeazzi Milan; Milan Italy
| | - C. Garutti
- Dermatology Unit; IRCCS Istituto Ortopedico Galeazzi Milan; Milan Italy
| | - E. Frigerio
- Dermatology Unit; IRCCS Istituto Ortopedico Galeazzi Milan; Milan Italy
| | - G. Banfi
- University of Milan; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - G. Altomare
- University of Milan; Milan Italy
- Dermatology Unit; IRCCS Istituto Ortopedico Galeazzi Milan; Milan Italy
| | - E. Reali
- Laboratory of Translational Immunology; IRCCS Istituto Ortopedico Galeazzi; Milan Italy
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Benham H, Norris P, Goodall J, Wechalekar MD, FitzGerald O, Szentpetery A, Smith M, Thomas R, Gaston H. Th17 and Th22 cells in psoriatic arthritis and psoriasis. Arthritis Res Ther 2013; 15:R136. [PMID: 24286492 PMCID: PMC3978433 DOI: 10.1186/ar4317] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/11/2013] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The aim of this study was to characterize interleukin 17 (IL-17) and interleukin 22 (IL-22) producing cells in peripheral blood (PB), skin, synovial fluid (SF) and synovial tissue (ST) in patients with psoriasis (Ps) and psoriatic arthritis (PsA). METHODS Flow cytometry was used to enumerate cells making IL-22 and IL-17, in skin and/or SF and PB from 11 patients with Ps and 12 patients with PsA; skin and PB of 15 healthy controls and SF from rheumatoid arthritis (RA) patients were used as controls. Expression of the interleukin 23 receptor (IL-23R) and chemokine receptors CCR4 and CCR6 was examined. Secretion of IL-17 and IL-22 was measured by ELISA. ST was analysed by immunohistochemical staining of IL-17 and IL-22. RESULTS Increased frequencies of IL-17+ and IL-22+ CD4+ T cells were seen in PB of patients with PsA and Ps. IL-17 secretion was significantly elevated in both PsA and Ps, whilst IL-22 secretion was higher in PsA compared to Ps and healthy controls. A higher proportion of the CD4+ cells making IL-17 or IL-22 expressed IL-23R and frequencies of IL-17+, CCR6+ and CCR4+ T cells were elevated in patients with Ps and those with PsA. In patients with PsA, CCR6+ and IL-23R + T cells numbers were elevated in SF compared to PB. Increased frequencies of IL-17+ and IL-22+ CD4+ T cells were demonstrated in Ps skin lesions. In contrast, whilst elevated frequencies of CD4+ IL-17+ cells were seen in PsA SF compared to PB, frequencies of CD4+ IL-22+ T cells were lower. Whereas IL-17 expression was equivalent in PsA, osteoarthritis (OA) and RA ST, IL-22 expression was higher in RA than either OA or PsA ST, in which IL-22 was strikingly absent. CONCLUSIONS Elevated frequencies of IL-17 and IL-22 producing CD4+ T cells were a feature of both Ps and PsA. However their differing distribution at disease sites, including lower frequencies of IL-22+ CD4+ T cells in SF compared to skin and PB, and lack of IL-22 expression in ST suggests that Th17 and Th22 cells have common, as well as divergent roles in the pathogenesis of Ps and PsA.
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MESH Headings
- Adult
- Aged
- Arthritis, Psoriatic/immunology
- Arthritis, Psoriatic/metabolism
- Arthritis, Psoriatic/pathology
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- CD4-Positive T-Lymphocytes/pathology
- Female
- Flow Cytometry
- Humans
- Immunohistochemistry
- Interleukin-17/blood
- Interleukin-17/cerebrospinal fluid
- Interleukin-17/immunology
- Interleukins/blood
- Interleukins/cerebrospinal fluid
- Interleukins/immunology
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/pathology
- Lymphocyte Count
- Male
- Middle Aged
- Psoriasis/immunology
- Psoriasis/metabolism
- Psoriasis/pathology
- Receptors, CCR4/immunology
- Receptors, CCR4/metabolism
- Receptors, CCR6/immunology
- Receptors, CCR6/metabolism
- Receptors, Interleukin/immunology
- Receptors, Interleukin/metabolism
- Skin/immunology
- Skin/metabolism
- Skin/pathology
- Synovial Membrane/immunology
- Synovial Membrane/metabolism
- Synovial Membrane/pathology
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Helper-Inducer/pathology
- Th17 Cells/immunology
- Th17 Cells/metabolism
- Th17 Cells/pathology
- Interleukin-22
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Affiliation(s)
- Helen Benham
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba QLD 4102, Australia
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Paul Norris
- Department of Dermatology Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Jane Goodall
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Mihir D Wechalekar
- Rheumatology Unit, Repatriation General Hospital, 216 Daws Rd, Daw Park, South Australia 5042, Australia
- Flinders University, Bedford Park, Sturt Rd, South Australia 5042, Australia
| | - Oliver FitzGerald
- Department of Rheumatology, St Vincent’s University Hospital, Merrion Rd, Dublin 4, and The Conway Institute for Biomolecular Research, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - Agnes Szentpetery
- Department of Rheumatology, St Vincent’s University Hospital, Merrion Rd, Dublin 4, and The Conway Institute for Biomolecular Research, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
| | - Malcolm Smith
- Rheumatology Unit, Repatriation General Hospital, 216 Daws Rd, Daw Park, South Australia 5042, Australia
- Flinders University, Bedford Park, Sturt Rd, South Australia 5042, Australia
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute, Translational Research Institute, 37 Kent Street, Woolloongabba QLD 4102, Australia
| | - Hill Gaston
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Novelli L, Chimenti MS, Chiricozzi A, Perricone R. The new era for the treatment of psoriasis and psoriatic arthritis: perspectives and validated strategies. Autoimmun Rev 2013; 13:64-9. [PMID: 24021172 DOI: 10.1016/j.autrev.2013.08.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/25/2013] [Indexed: 01/01/2023]
Abstract
Psoriatic Arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis. Psoriasis (PsO) is a chronic, inflammatory skin disease, characterized by hyperproliferation and aberrant differentiation of keratinocytes. PsA and PsO can be considered as a unique disease and are immune-mediated diseases and both innate and adaptive immunity play a role in their pathogenesis. Initially, PsO and PsA were thought to be Th1-mediated diseases, however, in the last years, several studies have shown the role of interleukin 17 (IL-17) and Th17 cells in the pathogenesis of PsA and PsO. Th17 cells have been detected in dermal infiltrates of psoriatic lesions as well as in synovial fluid. Interleukin (IL)-23, produced by antigen presenting cells (APC), especially by dendritic cells (DC), is the key regulator cytokine for Th17 and IL-17 production. In this review we discuss the role of IL-17 and IL-23 in the pathogenesis of PsO and PsA and their role as therapeutic targets for PsO and PsA treatment.
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Affiliation(s)
- Lucia Novelli
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, University of Tor Vergata, Rome, Italy
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Angiogenic and inflammatory properties of psoriatic arthritis. ISRN DERMATOLOGY 2013; 2013:630620. [PMID: 23819059 PMCID: PMC3683428 DOI: 10.1155/2013/630620] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/15/2013] [Indexed: 12/29/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis and included in seronegative spondyloarthropathy. PsA has several unique characteristics different from rheumatoid arthritis (RA), such as enthesopathy, dactylitis, and abnormal bone remodeling. As compared with synovitis of RA (pannus), proliferation of PsA synovium is mild and characterized by hypervascularity and increased infiltration of polymorphonuclear leukocytes in the synovial tissues. Angiogenesis plays a crucial role in cutaneous psoriasis, and several angiogenic factors such as vascular endothelial growth factor, interleukin-8, angiopoietin, tumor necrosis factor- α and transforming growth factor-β, are suggested to play an important role also in the pathophysiology of PsA. Further, IL-17 has various functions such as upregulation of proinflammatory cytokines, attraction of neutrophils, stimulation of keratinocytes, endothelial cell migration, and osteoclast formation via RANKL from activated synovial fibroblasts. Thus, IL-17 may be important in angiogenesis, fibrogenesis, and osteoclastogenesis in PsA. In this paper, roles of angiogenesis in the psoriatic synovium are discussed, which may strengthen the understanding of the pathogenesis of PsA.
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Hughes M, Chinoy H. Successful use of tocilizumab in a patient with psoriatic arthritis. Rheumatology (Oxford) 2013; 52:1728-9. [DOI: 10.1093/rheumatology/kes432] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Reveille JD. Spondyloarthritis. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hartung W, Ehrenstein B, Wallisch R, Fleck M. Remission of arthritis but persistent cutaneous lesions following tocilizumab treatment in a RA-patient suffering from concomitant psoriasis. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/crcm.2013.21018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chou CT. Why is biologic therapy useful in spondyloarthritis? Knowledge from synovial immunopathologic studies of spondyloarthritis. Int J Rheum Dis 2012; 15:507-11. [PMID: 23253232 DOI: 10.1111/1756-185x.12006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The pathogenesis of most rheumatic diseases remains unknown. It is believed that both genetic and environmental factors play a pivotal role in the development of synovial inflammation in rheumatoid arthritis (RA), spondyloarthritis (SpA) and osteoarthritis (OA). In the last two decades, there have been many immunopathologic studies on RA, SpA and OA, and the findings revealed different types of arthritis may also present different pathologic patterns. These included higher vascularity and increased infiltration with CD163 macrophages and neutrophils, but relatively low values for lining cell (LL) hyperplasia in SpA synovium. However, the increased LL hyperplasia, as well as CD1a+ cells and the presence of intracellular citrullinated protein were more prominent in RA than in SpA synovitis. Anti-tumor necrosis factor alpha (anti-TNFα) therapy can significantly reduce synovial LL hyperplasia, vascularity and mononuclear cells infiltration in the majority of RA or SpA patients. This may explain why clinically, arthritis patients can get significant improvement after TNFα blocker treatment.
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Affiliation(s)
- Chung-Tei Chou
- Division of Allergy-Immunology-Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Zhang LY, Ogdie AR, Schumacher HR. Light and electron microscopic features of synovium in patients with psoriatic arthritis. Ultrastruct Pathol 2012; 36:207-18. [PMID: 22849522 DOI: 10.3109/01913123.2011.651523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Few ultrastructural studies have been reported in psoriatic arthritis (PsA). The authors report a series of synovial biopsies with emphasis on patients with early disease to look for distinctive light (LM) and electron microscopic (EM) features of possible importance. METHODS The authors examined synovial biopsies obtained primarily by needle biopsy from 13 PsA patients using LM and/or EM. Sections from 12 patients were evaluated by LM for vascularity, synovial lining thickness, fibrin deposition, and inflammation via a semi-quantitative scale. Nine EM specimens were descriptively analyzed. Clinical, synovial fluid (SF), and radiographic characteristics were recorded. RESULTS Patients were mostly male, with mean disease duration before biopsy of 2.19 ± 2.60 years; 7 patients had arthritis for less than 1 year. All patients had peripheral arthritis, 2 had axial involvement. SFs disclosed predominance of polymorphonuclear leukocytes. LM demonstrated proliferation of synovial lining cells, lymphocyte and plasma cell infiltration, as well as dramatic clusters of small vessels in the superficial synovium. EMs showed more detailed vascular changes, including small, subendothelial, electron-dense deposits and scattered microparticles in vessel lumens and walls. CONCLUSIONS Prominent vascularity is confirmed as an important feature of some PsA. Vascular changes and other features, including the first EM demonstration of microparticles in PsA (identified as potent factors in other inflammatory joint diseases), are potential targets for therapy.
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Affiliation(s)
- Li Yun Zhang
- Division of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
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Chimenti MS, Ballanti E, Perricone C, Cipriani P, Giacomelli R, Perricone R. Immunomodulation in psoriatic arthritis: focus on cellular and molecular pathways. Autoimmun Rev 2012. [PMID: 23183378 DOI: 10.1016/j.autrev.2012.10.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with psoriasis. Pathogenesis is incompletely understood and pathophysiological role of synovium is just beginning to be elucidated. PsA could be considered an enthesal disease and this hypothesis is the link between mechanical stress (entheses) and immunologically active tissue (synovium). Histologically, PsA is characterized by lining layer hyperplasia, diffuse infiltrate of B, T, macrophages and dendritic cells associated with neutrophils' proliferation and angiogenesis. T cells are present, and oligoclonal T-cell expansions have been demonstrated in both skin and synovium. Histological findings are associated with monocyte-derived cytokines expression, as Myeloid-related protein (S100A8/A9). They play an important role in intracellular functions and cytoskeleton-membrane interactions. S100A8/A9 has a role in the propagation and perpetuation of the inflammatory process in patients with psoriasis and PsA, because of an activated monocyte/macrophage system that involve, distal to the skin, the "enthesal-complex." Complement system can be considered part of the acute phase response as demonstrated by higher plasma levels of C3 and C4 complement components in PsA patients compared with healthy subjects. These abnormal levels are then reverted by anti-TNF drugs. Evidences of efficacy of anti-TNF are expressed by reduction of vascularity and immune cells in synovial tissue. Therefore, innate response generates high concentrations of inflammatory cytokines which promote effector functions of a variety of tissue cells and sustain the characteristic chronicity of synovitis. The challenge will be the development of molecules affecting the balance between innate and adaptive immunity without affecting beneficial functions of the perfect concert of immunological process.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
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Cañete JD. Biopatología de la membrana sinovial en la artritis psoriásica. ACTA ACUST UNITED AC 2012; 8 Suppl 1:S10-4. [DOI: 10.1016/j.reuma.2011.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 12/19/2022]
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