EXTENDED REPORT

Early effects of tumour necrosis factor blockade on skin and synovial tissue in patients with active psoriasis and psoriatic arthritis

A Y Goedkoop^1,2, M C Kraan¹, M B M Teunissen², D I Picavet², M A de Rie², J D Bos², P P Tak¹

¹ Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands
² Department of Dermatology, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands

Correspondence to:
Correspondence to:
Professor P P Tak
Division of Clinical Immunology and Rheumatology, F4-218, Academic Medical Centre/University of Amsterdam, Meibergdreef 9, NL-1105 AZ Amsterdam, The Netherlands; P.P.Tak{at}amc.uva.nl

Background: Tumour necrosis factor (TNF) blockade using infliximab, a chimeric anti-TNF antibody, is an effective treatment for both psoriasis and psoriatic arthritis (PsA).

Objective: To analyse the early effects of infliximab treatment on serial skin and synovial tissue biopsy samples.

Methods: Twelve patients with both active psoriasis and PsA received a single infusion of either infliximab (3 mg/kg) (n = 6) or placebo (n = 6) intravenously. Synovial tissue and lesional skin biopsy specimens were obtained at baseline and 48 hours after treatment. Immunohistochemical analysis was performed to analyse the inflammatory infiltrate. In situ detection of apoptotic cells was performed by TUNEL assay and by immunohistochemical staining with anti-caspase-3 antibodies. Stained tissue sections were evaluated by digital image analysis.

Results: A significant reduction in mean (SEM) T cell numbers was found in both lesional epidermis (baseline 37 (11) cells/mm, 48 hours 26 (11), p = 0.028) and synovial tissue (67 (56) cells/mm²v 32 (30), p = 0.043) after infliximab treatment, but not after placebo treatment (epidermis 18 (8) v 43 (20), NS; synovium 110 (62) v 46 (21), NS). Similarly, the number of macrophages in the synovial sublining was significantly reduced after anti-TNF treatment (100 (73) v 10 (8), p = 0.043). The changes in cell numbers could not be explained by induction of apoptosis at the site of inflammation.

Conclusions: The effects of anti-TNF therapy in psoriasis and psoriatic arthritis may be explained by decreased cell infiltration in lesional skin and inflamed synovial tissue early after initiation of treatment.

Abbreviations: MTX, methotrexate; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNF, tumour necrosis factor

Keywords: immunotherapy; anti-tumour necrosis factor ; psoriasis; psoriatic arthritis

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