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Abatacept
could be considered a valid treatment option for PsA as it significantly
reduced synovial regulatory T-cell expression and improved clinical outcomes in
PsA with negligible effect on skin-related outcomes.
Psoriatic arthritis is a chronic autoimmune inflammatory disease affecting peripheral joints entheses and axial sites along with skin and nails. Szentpetery A et. Al., analyzed the 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).
This single-centered,
crossover study, recruited 15 PsA patients with active disease including
synovitis of a knee and naïve to biological-treatment. The patient randomly
received intravenous abatacept 3 mg/kg of body weight or placebo infusion on
day 1, 15 and 29. After this abatacept 10 mg/kg of body weight was administered
every 28 days for 5 months and the data was collected during each visit.
Synovial biopsy of the involved knee was obtained at baseline, 2 and 6 months.
Before arthroscopy, MRI of the same knee and skin biopsy was also performed.
Significant
improvements was seen in the joint-related measures, in which 90% were European
League Against Rheumatism criteria responders and 30% achieved psoriasis area
severity index (PASI) 50 at 6 months. Synovitis (P=0.016) and vascularity
(P=0.039) macroscopic scores were found to decrease consistently with decrease
in total MRI score (P=0.016). Abatacept brought a decrease in the
immunohistological expression of FOXP3+ cells (P=0.027), mainly the expression
of CD4+FOXP3+ regulatory T cells (Tregs) (P=0.008) in the synovium over 6
months. As such no significant clinical or immunohistological change in any of
the skin measures was observed.
Arthritis Research & Therapy
Abatacept reduces synovial regulatory T-cell expression in patients with psoriatic arthritis
Agnes Szentpetery et. al.
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