Top

12-01-2016 | Psoriatic arthritis | Book Chapter | Article

7. Immunopathology of the Psoriatic Arthritis Musculoskeletal Lesions

Author: Kurt de Vlam, MD, PhD

Publisher: Springer International Publishing

Abstract

Psoriatic arthritis is a complex inflammatory joint disease associated with psoriasis. The immunopathology of the skin and joint involvement resembles each other in some aspects but not all of them. Joint involvement is characterized by hypervascularity, cellular hypertrophy and inflammatory cellular infiltrate. Lymphocytes and dendritic cells play an important role in the pathogenesis of psoriasis and psoriatic arthritis; Their role in the early and late phase of the disease has still to be elucidated. Among the lymphocytes there is an important role for the Th17 cells linking the innate and adaptive immune systems. Future therapies are focusing on these effector cells and their products. Pre-osteoclasts and mature osteoclasts are other important players in the disease process, especially in psoriatic arthritis.

The immunopathology of psoriatic arthritis is just at the early beginning of unravelling its secrets.

Scarpa R, Ayala F, Caporaso N, Olivieri I. Psoriasis, psoriatic arthritis, or psoriatic disease? J Rheumatol. 2006;33(2):210–2.PubMed

Ritchlin C. Psoriatic disease--from skin to bone. Nat Clin Pract Rheumatol. 2007;3(12):698–706. Review.PubMedCrossRef

McGonagle D, McDermott MF. A proposed classification of the immunological diseases. PLoS Med. 2006;3(8):e297.PubMedPubMedCentralCrossRef

McGonagle D, Ash Z, Dickie L, McDermott M, Aydin SZ. The early phase of psoriatic arthritis. Ann Rheum Dis. 2011;70 Suppl 1:i71.PubMedCrossRef

Fearon U, Reece R, Smith J, Emery P, Veale DJ. Synovial cytokine and growth factor regulation of MMPs/TIMPs: implications for erosions and angiogenesis in early rheumatoid and psoriatic arthritis patients. Ann N Y Acad Sci. 1999;878:619–21.PubMedCrossRef

Kuroda K, Sapadin A, Shoji T, Fleischmajer R, Lebwohl M. Altered expression of angiopoietins and Tie2 endothelium receptor in psoriasis. J Invest Dermatol. 2001;116(5):713–20.PubMedCrossRef

Kruithof E, Baeten D, De Rycke L, Vandooren B, Foell D, Roth J, Cañete JD, Boots AM, Veys EM, De Keyser F. Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis. Arthritis Res Ther. 2005;7(3):R569–80.PubMedPubMedCentralCrossRef

Gudbjörnsson B, Christofferson R, Larsson A. Synovial concentrations of the angiogenic peptides bFGF and VEGF do not discriminate rheumatoid arthritis from other forms of inflammatory arthritis. Scand J Clin Lab Invest. 2004;64(1):9–15.PubMedCrossRef

Fearon U, Griosios K, Fraser A, Reece R, Emery P, Jones PF, Veale DJ. Angiopoietins, growth factors, and vascular morphology in early arthritis. J Rheumatol. 2003;30(2):260–8.PubMed

10.

Veale D, Yanni G, Rogers S, Barnes L, Bresnihan B, Fitzgerald O. Reduced synovial membrane ELAM-1 expression, macrophage numbers and lining layer hyperplasia in psoriatic arthritis as compared with rheumatoid arthritis. Arthritis Rheum. 1993;36:893–900. 2.PubMedCrossRef

11.

Cañete JD, Santiago B, Cantaert T, Sanmartí R, Palacin A, Celis R, Graell E, Gil-Torregrosa B, Baeten D, Pablos JL. Ectopic lymphoid neogenesis in psoriatic arthritis. Ann Rheum Dis. 2007;66(6):720–6.PubMedPubMedCentralCrossRef

12.

Emad Y, Ragab Y, Gheita T, Anbar A, Kamal H, Saad A, Darweesh H, El-Shaarawy N, Azab A, Ismail A, Rasker JJ, Knee Enthesitis Working Group. Knee enthesitis and synovitis on magnetic resonance imaging in patients with psoriasis without arthritic symptoms. J Rheumatol. 2012;39(10):1979–86.PubMedCrossRef

13.

Laloux L, Voisin MC, Allain J, Martin N, Kerboull L, Chevalier X, Claudepierre P. Immunohistological study of entheses in spondyloarthropathies: comparison in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis. 2001;60(4):316–21.PubMedPubMedCentralCrossRef

14.

McGonagle D, Marzo-Ortega H, O’Connor P, Gibbon W, Hawkey P, Henshaw K, Emery P. Histological assessment of the early enthesitis lesion in spondyloarthropathy. Ann Rheum Dis. 2002;61:534–7.PubMedPubMedCentralCrossRef

15.

McGonagle D, Gibbon W, O’Connor P, Green M, Pease C, Emery P. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum. 1998;41(4):694–700.PubMedCrossRef

16.

Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol. 1995;24(5):351–5.PubMedCrossRef

17.

Lories RJ, Matthys P, de Vlam K, Derese I, Luyten FP. Ankylosing enthesitis, dactylitis, and onychoperiostitis in male DBA/1 mice: a model of psoriatic arthritis. Ann Rheum Dis. 2004;63(5):595–8.PubMedPubMedCentralCrossRef

18.

Tassiulas I, Duncan SR, Centola M, Theofilopoulos AN, Boumpas DT. Clonal characteristics of T cell infiltrates in skin and synovium of patients with psoriaticarthritis. Hum Immunol. 1999;60(6):479–91. 28.PubMedCrossRef

19.

Chang JC, Smith LR, Froning KJ, Schwabe BJ, Laxer JA, Caralli LL, Kurkland HH, Karasek MA, Wilkinson DI, Carlo DJ. CD8+ T-cells in psoriatic lesions preferentially use T-cell receptors V beta 3 and/or V beta 13.1 genes. Ann N Y Acad Sci. 1995;756:370–81.PubMedCrossRef

20.

Veale DJ, Barnes L, Rogers S, FitzGerald O. Immunohistochemical markers for arthritis in psoriasis. Ann Rheum Dis. 1994;53:450–4.PubMedPubMedCentralCrossRef

21.

Lee E, Trepicchio WL, Oestreicher JL, Pittman D, Wang F, Chamian F, Dhodapkar M, Krueger JG. Increased expression of interleukin 23 p19 and p40 in lesional skin of patients with psoriasis vulgaris. J Exp Med. 2004;199(1):125–30.PubMedPubMedCentralCrossRef

22.

Menon B, Gullick NJ, Walter GJ, Rajasekhar M, Garrood T, Evans HG, Taams LS, Kirkham BW. Interleukin-17 + CD8+ T cells are enriched in the joints of patients with psoriatic arthritis and correlate with disease activity and joint damage progression. Arthritis Rheumatol. 2014;66(5):1272–81.PubMedPubMedCentralCrossRef

23.

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(5):R136.PubMedPubMedCentralCrossRef

24.

Diani M, Altomare G, Reali E. T cell responses in psoriasis and psoriatic arthritis. Autoimmun Rev. 2015;14(4):286–92.PubMedCrossRef

25.

Jongbloed SL, Lebre MC, Fraser AR, Gracie JA, Sturrock RD, Tak PP, McInnes IB. Enumeration and phenotypical analysis of distinct dendritic cell subsets in psoriatic arthritis and rheumatoid arthritis. Arthritis Res Ther. 2006;8(1):R15.PubMedPubMedCentralCrossRef

26.

Lande R, Giacomini E, Serafini B, Rosicarelli B, Sebastiani GD, Minisola G, Tarantino U, Riccieri V, Valesini G, Coccia EM. Characterization and recruitment of plasmacytoid dendritic cells in synovial fluid and tissue of patients with chronic inflammatory arthritis. J Immunol. 2004;173(4):2815–24.PubMedCrossRef

27.

Wenink MH, Santegoets KC, Butcher J, van Bon L, Lamers-Karnebeek FG, van den Berg WB, van Riel PL, McInnes IB, Radstake TR. Impaired dendritic cell proinflammatory cytokine production in psoriatic arthritis. Arthritis Rheum. 2011;63(11):3313–22.PubMedCrossRef

28.

Aochi S, Tsuji K, Sakaguchi M, Huh N, Tsuda T, Yamanishi K, Komine M, Iwatsuki K. Markedly elevated serum levels of calcium-binding S100A8/A9 proteins in psoriatic arthritis are due to activated monocytes/macrophages. J Am Acad Dermatol. 2011;64(5):879–87.PubMedCrossRef

29.

Ritchlin CT, Haas-Smith SA, Li P, Hicks DG, Schwarz EM. Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest. 2003;111(6):821–31.PubMedPubMedCentralCrossRef

30.

Colucci S, Brunetti G, Cantatore FP, Oranger A, Mori G, Quarta L, Cirulli N, Mancini L, Corrado A, Grassi FR, Grano M. Lymphocytes and synovial fluid fibroblasts support osteoclastogenesis through RANKL, TNFalpha, and IL-7 in an in vitro model derived from human psoriatic arthritis. J Pathol. 2007;212(1):47–55.PubMedCrossRef

31.

Chiu YG, Shao T, Feng C, Mensah KA, Thullen M, Schwarz EM. Ritchlin CT.CD16 (FcRgammaIII) as a potential marker of osteoclast precursors in psoriatic arthritis. Arthritis Res Ther. 2010;12(1):R14.PubMedPubMedCentralCrossRef

32.

Chiu YG, Ritchlin CT. Characterization of DC-STAMP+ Cells in Human Bone Marrow. J Bone Marrow Res. 2013;1:1–14

33.

Anandarajah AP, Schwarz EM, Totterman S, Monu J, Feng CY, Shao T, Haas-Smith SA, Ritchlin CT. The effect of etanercept on osteoclast precursor frequency and enhancing bone marrow oedema in patients with psoriatic arthritis. Ann Rheum Dis. 2008;67(3):296–301.PubMedCrossRef

34.

Lories RJ, de Vlam K. Is psoriatic arthritis a result of abnormalities in acquired or innate immunity? Curr Rheumatol Rep. 2012;14(4):375–82.PubMedCrossRef

Medicine Matters Rheumatology

Abstract