Marked increase in the frequency of psoriatic arthritis in psoriasis patients with hla–dr+ keratinocytes

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Abstract
Immunocytochemical studies with a monoclonal anti–HLA–DR antibody were performed on skin sections and keratinocyte (KTC) suspensions obtained from suction blisters of active psoriatic plaques. HLA–DR+ KTCs were found in the plaques of 23 of 38 patients with active psoriasis. Of these 23, 16 had clinical findings typical of psoriatic arthritis (PA); none of the 15 patients who lacked HLA–DR+ KTCs had PA. Although KTC HLA–DR expression was more prevalent in patients with severe skin disease, 7 of the 23 patients with HLA–DR + KTCs in active psoriatic plaques had mild skin disease; 4 of these 7 had PA. Nail pitting or duration of skin disease did not account for increased incidence of PA in patients with HLA–DR+ KTCs. All psoriasis patients with arthritis received nonsteroidal antiinflammatory drug therapy; 14 received additional therapy directed primarily to the cutaneous manifestations of psoriasis. Nine of these noted arthritis improvement with concurrent skin response; however, in 5 patients, arthritis activity increased, despite improvement of the cutaneous disease. Two other patients, treated with methotrexate, also had concurrent skin and joint improvement. These data suggest that psoriasis patients with HLA–DR + KTCs are at increased risk for the development of associated arthritis.

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