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This article is part of the supplement: 22nd European Workshop for Rheumatology Research

Meeting abstract

Alefacept treatment in psoriatic arthritis: reduction of the synovial inflammatory infiltrate and improvement of clinical signs of arthritis

MC Kraan1, HJ Dinant1, AWR van Kuijk2, AY Goedkoop1, TJM Smeets1, MA de Rie1, BAC Dijkmans2, AK Vaishnaw3 and PP Tak1

Author Affiliations

1 Academic Medical Center, Amsterdam, The Netherlands

2 Acad Hospital Free University, Amsterdam, The Netherlands

3 Biogen Inc., Cambridge, MA, USA

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Arthritis Res 2002, 4(Suppl 1):101  doi:10.1186/ar436

The electronic version of this article is the complete one and can be found online at:


Received:15 January 2002
Published:4 February 2002

©

Objective

Psoriasis and psoriatic arthritis (PsA) are thought of as T-cell mediated diseases. LFA-3/CD2 interaction plays a significant role in T-cell activation. Alefacept, an LFA3-IgG1 fusion protein, blocks LFA3-CD2 interactions resulting in inhibition of T-cell responses and T-cell apoptosis which could be beneficial in patients with active PsA.

Methods

Eleven patients with active PsA were treated with alefacept for 12 weeks in an open label design. Clinical joint assessment, Psoriasis Area and Severity Index (PASI), and peripheral blood (PB) assessments were performed at baseline, after 4,9,12, and 16 weeks of treatment. Serial synovial tissue (ST) biopsies of an index joint (knee, ankle, wrist or MCP joint) were obtained by arthroscopy at baseline, 4 and 12 weeks.

Results

At completion of treatment 6 out of 11 (56%) treated patients fulfilled the DAS response criteria, 9 patients (82%) fulfilled the DAS response criteria at any point within the study. Seven of 11 (64%) treated patients showed improvement (mean 50%) of their skin psoriasis. In the ST there was a statistically significant reduction in CD4+ lymphocytes (P < 0.05), CD8+ lymphocytes (P = 0.05), and CD68+ macrophages (P < 0.02) in the synovial samples after 12 weeks of treatment compared to baseline. Patients fulfilling the DAS response criteria demonstrated a higher baseline ration and significant reduction in CD4+CD45RO+ cells in both ST and PB where non-responders demonstrated only reductions in PB.

Conclusion

The improvement in clinical joint score, skin psoriasis, and changes in synovial tissue after treatment with alefacept supports the hypothesis that T-cell activation plays an important role in this chronic inflammatory disease. Furthermore, since alefacept, a specific T-cell agent, led to decreased macrophage activation, the data indicate that T cells orchestrate synovial inflammation in psoriatic arthritis.