Correlation between clinical manifestation and immuno-genetic determinants at patients with psoriatic arthritis in Republic of Moldova

Abstract

Objective. Psoriatic arthritis is an inflammatory joint disease associated or no with psoriasis and presents a heterogeneous clinical pattern, expressed by different manifestations such as poli-oligoarthritis from mild to very severe forms, erosive and destructive mutilate arthritis, DIP arthritis and very particular psoriatic axial diseases. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to analyze: • the prevalence of inflammatory manifestations, such as poliarthritis, oligoarthritis, axial disease, DIP arthritis and mutilate arthritis in patients with psoriatic arthritis in Republic of Moldova; • the clinical manifestations of psoriatic arthritis and associations with immunological disorders by appreciation of lymphocytes cell determinants (CD) with identifying markers for aggressive joint disease • the clinical manifestations of psoriatic arthritis and associations with human leukocyte antigens (HLA-antigens) and identifying markers for aggressive joint disease Material and method. Ninety nine patients with psoriatic arthritis with defined joint disease were examined clinically, radiologically, and with laboratory-based analyses. Disease classification and diagnosis have been based on CASPAR criteria. All patients who were included into the study selected from the Depts of Rheumatology of Clinical Republican Hospital and from the 3-rd Municipal Clinical Hospital and from the Dept of Dermatology which were invited to a prevalence study. Every patient was included in separate group from those five groups by Moll and Wright (poliarthritis, oligoarthritis, axial disease, DIP arthritis and mutilate arthritis) and statistical analyses have been done between these groups. The correlation of clinical manifestations and potential markers of aggressive joint disease with HLA associations and lymphocytes CD were analyzed in all patients with psoriatic arthritis which were included into the study. Results. We have found a high prevalence of HLA-B7, B17, B27, B37 and HLA-A2, A3, A7 and A29 which were increased in comparison with controls (p = 0.012, pc = 0.024, RRf = 3.1), but the strongest predictive factors among patients with poliarthritis and axial disease of psoriatic arthritis for an aggressive disease, in a multiple logistic analysis and polifactorial correlation, were HLA-A3, A29, B27, B37. A significant linkage (p = 0.0001, RRf = 2.9) was found. Ninety-four controls with the same ethnic background as the patients were randomly selected from the population of Republic of Moldova. An association was found between CD determinants of lymphocytes (CD2, CD3, CD4, CD8, CD19, CD20, CD22) and psoriatic arthritis, but most important were: for DPI arthritis and oligoarthritis CD3, CD8 in comparison with controls (p = 0.001, pc = 0.014, RRf = 3.1); for poliarthritis form CD2, CD4, CD8 in comparison with controls (p = 0.003, pc = 0.009, RRf = 2.6); for axial disease CD4, CD8 and CD22 in comparison with controls (p = 0.001, pc = 0.021, RRf = 3.5), and for mutilate arthritis CD2, CD4, CD19, CD20, CD22 in comparison with controls (p = 0.001, pc = 0.029, RRf = 2.8) with significant linkage for all groups (p = 0.001, RRf = 2.4-3.3). Conclusion. The prevalence of inflammatory joint manifestations, such as poliarthritis, axial disease and mutilate arthritis was high among patients with psoriatic arthritis in Republic of Moldova. There were several strong association between HLA-antigens (B7, B17, B27, B37, A2, A3, A7, A29), lymphocytes CD2, CD3, CD4, CD8, CD19, CD20, CD22 and psoriatic arthritis. The strongest predictive factors among patients with poliarthritis and axial disease of psoriatic arthritis for an aggressive disease were HLA-A3, A29, B27, B37 with a significant linkage (p = 0.0001, RRf = 2.9).