T-cells and proinflammatory cytokines seem to play important roles in the pathogenesis of psoriatic arthritis (PsA). TNF-α antagonists have shown remarkable therapeutic efficacy, reducing the progression of bone damage and improving the quality of life of PsA patients. A significant number of PsA patients do not respond or are intolerant to these therapies and require alternatives. Drugs interfering with T cell activation have shown variable effects in PsA. We describe a PsA patient with moderate-to-severe skin and nail disease, and severe polyarthritis refractory to anti-TNF therapy, which were successfully treated with abatacept. Synovial tissue cellular changes and changes in synovial fluid cytokines after 24 weeks of abatacept therapy are described. The excellent clinical response in our patient was paralleled by a reduction in synovial neutrophils, macrophages, and T-cells, and a substantial reduction in interferon-gamma and pro-inflammatory cytokine levels
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