Gottlieb A B, Fu S M, Carter D M, Fotino M
Arthritis Rheum. 1987 Aug;30(8):901-7. doi: 10.1002/art.1780300809.
Immunocytochemical studies with a monoclonal anti-HLA-DR antibody were performed on skin sections and keratinocyte (KTC) suspensions obtained from suction blisters of active psoriatic plaques. HLA-DR+ KTCs were found in the plaques of 23 of 38 patients with active psoriasis. Of these 23, 16 had clinical findings typical of psoriatic arthritis (PA); none of the 15 patients who lacked HLA-DR+ KTCs had PA. Although KTC HLA-DR expression was more prevalent in patients with severe skin disease, 7 of the 23 patients with HLA-DR+ KTCs in active psoriatic plaques had mild skin disease; 4 of these 7 had PA. Nail pitting or duration of skin disease did not account for increased incidence of PA in patients with HLA-DR+ KTCs. All psoriasis patients with arthritis received nonsteroidal antiinflammatory drug therapy; 14 received additional therapy directed primarily to the cutaneous manifestations of psoriasis. Nine of these noted arthritis improvement with concurrent skin response; however, in 5 patients, arthritis activity increased, despite improvement of the cutaneous disease. Two other patients, treated with methotrexate, also had concurrent skin and joint improvement. These data suggest that psoriasis patients with HLA-DR+ KTCs are at increased risk for the development of associated arthritis.
采用单克隆抗HLA - DR抗体对取自活动性银屑病斑块抽吸水疱的皮肤切片和角质形成细胞（KTC）悬液进行免疫细胞化学研究。在38例活动性银屑病患者中，有23例的斑块中发现了HLA - DR + KTC。在这23例患者中，16例有银屑病关节炎（PA）的典型临床表现；而在15例缺乏HLA - DR + KTC的患者中，无一例患有PA。尽管KTC HLA - DR表达在严重皮肤病患者中更为普遍，但在活动性银屑病斑块中有HLA - DR + KTC的23例患者中，7例患有轻度皮肤病；这7例中有4例患有PA。甲凹点或皮肤病病程并不能解释HLA - DR + KTC患者中PA发病率的增加。所有患有关节炎的银屑病患者均接受了非甾体抗炎药治疗；14例还接受了主要针对银屑病皮肤表现的额外治疗。其中9例患者在皮肤症状改善的同时关节炎也有所改善；然而，有5例患者尽管皮肤病有所改善，但关节炎活动度却增加了。另外2例接受甲氨蝶呤治疗的患者，皮肤和关节症状也同时得到改善。这些数据表明，具有HLA - DR + KTC的银屑病患者发生相关关节炎的风险增加。
