滑膜炎-痤疮-脓疱病-骨肥厚-骨炎综合征和银屑病关节炎表现出不同的免疫遗传学特征。

Synovitis-acne-pustulosis-hyperostosis-osteitis syndrome and psoriatic arthritis exhibit a different immunogenetic profile.

作者信息

Queiro R, Moreno P, Sarasqueta C, Alperi M, Riestra J L, Ballina J

机构信息

Rheumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.

出版信息

Clin Exp Rheumatol. 2008 Jan-Feb;26(1):125-8.

PMID:18328159

Abstract

BACKGROUND AND OBJECTIVES

Patients with psoriatic arthritis (PsA) as well as those with synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome share some common features, and in fact, for many authors the SAPHO concept fits well into the broader concept of PsA. However, some clinical features are unique to the SAPHO syndrome, and in the other hand, these patients do not show the known association between the HLA-B27 antigen and the spondyloarthropathies. To date, there are no studies comparing the immunogenetic profile of these two conditions, so the main objective of the present report was to analyse whether or not both entities may share the same genetic basis.

PATIENTS AND METHODS

All patients with SAPHO syndrome (n=25) seen in a single university hospital from 1985 to 2005 were recruited and followed up in standardised manner in order to study their main characteristics and HLA profile. The HLA-Cw6, DR and B27 antigen distribution of these cases was compared to that of 50 patients with psoriasis vulgaris, 120 with PsA, and 170 healthy blood donors. PsA patients were classified in accordance with their predominant pattern observed in the last 5 years of disease evolution. Odds ratios (OR) values were calculated to measure the strength of the association between HLA antigens and disease, while the statistical significance of the association was assessed with a two-tailed Fisher's exact test. P<0.05 values were considered significant.

RESULTS

No association was found between HLA-Cw6, B27, or DR antigens, and SAPHO syndrome. HLA-Cw6 was strongly associated with psoriasis, OR 12 (95% CI: 5.6-26, p<0.0001) and PsA, OR 10 (95% CI: 5.4-19.5, p<0.0001), however this antigen was equally distributed among the three articular categories of PsA. HLA-DR4 was found under-represented in PsA patients compared to controls, OR 0.4 (95% CI: 0.2-0.7, p=0.002). HLA-DR7 correlated well with psoriatic oligoarthritis, OR 9.6 (95% CI: 2.9-28, p<0.0001), HLA-DR8 was found associated with polyarthritis, OR 6.7 (95% CI: 2-25, p=0.002), while HLA-B27 was over-represented in psoriatic spondylitis, OR 10 (95% CI: 3.3-25, p<0.0001).

CONCLUSIONS

Psoriasis/PsA and SAP-HO syndrome show a different immunogenetic background, however the genetic basis of SAPHO syndrome remains unknown.

摘要

背景与目的

银屑病关节炎（PsA）患者以及滑膜炎、痤疮、脓疱病、骨肥厚、骨炎（SAPHO）综合征患者有一些共同特征，事实上，对许多作者而言，SAPHO概念很好地契合了PsA这一更广泛的概念。然而，一些临床特征是SAPHO综合征所特有的，另一方面，这些患者未显示出HLA - B27抗原与脊柱关节病之间已知的关联。迄今为止，尚无比较这两种病症免疫遗传学特征的研究，因此本报告的主要目的是分析这两种病症是否可能具有相同的遗传基础。

患者与方法

招募了1985年至2005年在一家大学医院就诊的所有SAPHO综合征患者（n = 25），并以标准化方式进行随访，以研究其主要特征和HLA谱。将这些病例的HLA - Cw6、DR和B27抗原分布与50例寻常型银屑病患者、120例PsA患者以及170名健康献血者的分布进行比较。根据PsA患者疾病演变最后5年观察到的主要模式进行分类。计算优势比（OR）值以衡量HLA抗原与疾病之间关联的强度，同时用双侧Fisher精确检验评估关联的统计学意义。P < 0.05的值被认为具有统计学意义。

结果

未发现HLA - Cw6、B27或DR抗原与SAPHO综合征之间存在关联。HLA - Cw6与银屑病强烈相关，OR为12（95%CI：5.6 - 26，p < 0.0001），与PsA也强烈相关，OR为10（95%CI：5.4 - 19.5，p < 0.0001），然而该抗原在PsA的三种关节类型中分布相同。与对照组相比，PsA患者中HLA - DR4的表达不足，OR为0.4（95%CI：0.2 - 0.7，p = 0.002）。HLA - DR7与银屑病性寡关节炎相关性良好，OR为9.6（95%CI：2.9 - 28，p < 0.0001），HLA - DR8与多关节炎相关，OR为6.7（95%CI：2 - 25，p = 0.002），而HLA - B27在银屑病性脊柱炎中表达过高，OR为10（95%CI：3.3 - 25，p < 0.0001）。