Human leukocyte antigen and demographic characteristics in Chinese patients with active peripheral type psoriatic arthritis who had inadequate response to conventional disease-modifying antirheumatic drugs in a single dermatologic clinic

Abstract

BackgroundCorrelation between severity of psoriasis and psoriatic arthritis (PsA) is inconsistent. Also, human leukocyte antigen (HLA)-Cw6 was found to be underrepresented in severe psoriasis who failed conventional systemic therapies, but the effect of HLA polymorphism on PsA severity needs to be confirmed.ObjectivesTo describe the severity of psoriasis, demographic features and HLA polymorphism among Chinese patients with active peripheral type PsA who had inadequate response to conventional disease-modifying antirheumatic drugs.MethodsWe included all patients with PsA who had at least 3 tender and swollen peripheral joints despite at least two conventional non-biologic treatments in our clinic. Demographic results were compared with global pivotal studies of biologics for PsA. HLA-Cw and HLA-DRB1 genotyping was also analyzed.ResultsWe identified 60 patients who met our inclusion criteria. The male to female ratio was 1.31:1. The majority of patients presented with psoriasis first (81.7%). The mean interval between psoriasis and PsA was 7.2 ± 8.1 years (mean ± SD). The baseline number of tender and swollen joints was 14.9 ± 10.7 and 11.3 ±10.2, respectively. In total, 41.7% subjects had more than 3% body surface area involvement of psoriasis. Genotyping of HLA-Cw and HLA-DRB1 was performed in 47 subjects. HLA-Cw*0702 was the most frequent allele (29.8%), followed by HLA-Cw*01 (26.6%). The frequency of HLA-Cw*0602 allele was similar to normal population. The most frequent HLA-DRB1 allele was HLA-DRB1*04 (20.2%), followed by HLA-DRB1*08 (16.0%). No cases carrying HLA-DRB1*13 were detected.ConclusionsCompared with Western population, our patients had less psoriasis and PsA burden. The frequencies of HLA-Cw*06, HLA-Cw*12, and HLA-DRB1*07 were not increased. In contrast, HLA-Cw*0702 and HLA-DRB1*08 allele frequencies were increased compared with psoriasis patients and normal population in Taiwan. Future studies are still needed to characterize the demographic and genetic features of high need PsA patients.

HLA-Cw1 and Psoriasis

“…The HLA-Cw1 allele was increased in Spanish patients with psoriatic arthritis, especially the axial type, although this association may be secondary to the linkage between HLA-B27.5 and HLA-Cw1 [60]. In one study, genotyping was performed in 47 Chinese patients with active peripheral-type psoriatic arthritis despite conventional treatment, HLA-Cw*07:02 was the most frequent allele (29.8%), followed by HLA-C*01 (26.6%) [61]. Shao et al described four phenotypes with a significant positive association with psoriatic arthritis, including HLA-C*01, *02, *06, and *12, in a meta-analysis of European and Middle Eastern descent [62].…”

Psoriasis and systemic lupus erythematosus in children – literature review based on case report

“…The genes that predispose to the development of Ps include HLA-B27, HLA-Cw6, HLA-DR7 and HLA-DRB1 [15,[29][30][31][32], as well as polymorphisms of many non-HLA genes, such as PSORS 3 on chromosome 4q or the 4q27, 16q12 and 1p13 loci, as well as the 5q31 locus, which is associated with Ps, RA, asthma and atopic dermatitis [30]. Epigenetic mechanisms, DNA hypermethylation, histone H4 hypoacetylation and abnormal microRNA expression lead to T cell hyperactivation.…”

“…Despite the discrepancies, both disease entities do share some features. In terms of genetic predisposition, these include the above-mentioned HLA-DRB1 and the polymorphisms of several loci outside of the major histocompatibility complex, such as 16q12, 1p13 and 4q27 [30], especially in the Chinese population, s8016947 and rs4649203 [6].…”

Combination Therapy for Psoriasis with Methotrexate and Other Oral Disease-Modifying Antirheumatic Drugs: A Systematic Review

“…While monotherapy using DMARDs is usually given by dermatology for psoriasis, combinational use of DMARDs is also common in other specialties, including rheumatology [ 19 ], transplantation, and gastroenterology (for inflammatory bowel disease). In pivotal studies of biologics in patients with psoriatic arthritis, about 50% of patients received concomitant MTX [ 20 ]. In general, biologics plus MTX resulted in better efficacy for psoriasis lesions compared with biologic monotherapy, with no difference in tolerability [ 21 ].…”