RESEARCH - Analysis of cell infiltrate and expression of mediators of synovial inflammation & joint destruction in PsA

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Published Online First: 25 May 2006. doi:10.1136/ard.2005.050963

ls of the Rheumatic Diseases 2006;65:1551-1557

© 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Detailed analysis of the cell infiltrate and the expression of mediators of

synovial inflammation and joint destruction in the synovium of patients with

psoriatic arthritis: implications for treatment

A W R van Kuijk1, P Reinders-Blankert1, T J M Smeets1, B A C Dijkmans2 and P

P Tak1

1 Division of Clinical Immunology and Rheumatology Academic Medical

Center/University of Amsterdam, Amsterdam, The Netherlands

2 Department of Rheumatology, VU University Medical Center, Amsterdam, The

Netherlands

Correspondence to:

A W R van Kuijk

Division of Clinical Immunology and Rheumatology, Academic Medical

Center/University of Amsterdam, F4-218, PO Box 22700, 1100 DE Amsterdam, The

Netherlands; a.w.vankuijk@...

Background: The synovial tissue is a primary target of many inflammatory

arthropathies, including psoriatic arthritis (PsA). Identification of

proinflammatory molecules in the synovium may help to identify potentially

therapeutic targets.

Objective: To investigate extensively the features of cell infiltration and

expression of mediators of inflammation and joint destruction in the

synovium of patients with PsA compared with patients with rheumatoid

arthritis matched for disease duration and use of drugs.

Methods: Multiple synovial tissue biopsy specimens were obtained by

arthroscopy from an inflamed joint in 19 patients with PsA (eight

oligoarthritis, 11 polyarthritis) and 24 patients with rheumatoid arthritis.

Biopsy specimens were analysed by immunohistochemistry to detect T cells,

plasma cells, fibroblast-like synoviocytes, macrophages, proinflammatory

cytokines, matrix metalloproteinases and tissue inhibitor

metalloproteinase-1, adhesion molecules and vascular markers. Stained

sections were evaluated by digital image analysis.

Results: The synovial infiltrate of patients with PsA and rheumatoid

arthritis was comparable with regard to numbers of fibroblast-like

synoviocytes and macrophages. T cell numbers were considerably lower in the

synovium of patients with PsA. The number of plasma cells also tended to be

lower in PsA. The expression of tumour necrosis factor alpha (TNF),

interleukin (IL) 1ß, IL6 and IL18 was as high in PsA as in rheumatoid

arthritis. The expression of matrix metalloproteinases, adhesion molecules

and vascular markers was comparable for PsA and rheumatoid arthritis.

Conclusion: These data show increased proinflammatory cytokine expression in

PsA synovium, comparable to results obtained for rheumatoid arthritis, and

support the notion that, in addition to TNF blockade, there may be a

rationale for treatments directed at IL1ß, IL6 and IL18.

http://ard.bmj.com/cgi/content/abstract/65/12/1551

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