臨床整形外科59巻4号

2024年04月発行

特集 脊椎関節炎SpAを理解する—疾患概念・診断基準・最新治療

乾癬性関節炎(PsA)の疫学，病態

著者： 和田琢¹

所属機関： ¹埼玉医科大学リウマチ膠原病科

ページ範囲：P.361 - P.367

乾癬性関節炎(PsA)は，乾癬に関節炎を伴う炎症性筋骨格系疾患であり，機械的刺激のかかる付着部に炎症が惹起されるのが特徴である．PsAの病態はHLA-B27などの遺伝的要因とメカニカルストレスに代表される環境要因を背景に，近年治療ターゲットにもなっているIL-23，IL-17，TNFなどのサイトカインが関与し，炎症だけでなく，付着部骨棘や靱帯骨棘に代表される特徴的な骨新生を呈する．また，PsA患者は肥満やメタボリックシンドロームの頻度も高く，PsAの病態に関与することが考えられている．

参考文献

1) Schett G, Lories RJ, D'Agostino MA, et al. Enthesitis:from pathophysiology to treatment. Nat Rev Rheumatol 2017;13(12):731-41.

2) Ohara Y, Kishimoto M, Takizawa N, et al. Prevalence and clinical characteristics of psoriatic arthritis in Japan. J Rheumatol 2015;42(8):1439-42.

3) Yamamoto T, Kawada A. Clinical characteristics of Japanese patients with psoriatic arthritis:comparison with East Asian countries. J Dermatol 2018;45(3):273-8.

4) Chandran V, Tolusso DC, Cook RJ, et al. Risk factors for axial inflammatory arthritis in patients with psoriatic arthritis. J Rheumatol 2010;37(4):809-15.

5) Alamanos Y, Papadopoulos NG, Voulgari PV, et al. Epidemiology of psoriatic arthritis in northwest Greece, 1982-2001. J Rheumatol 2003;30(12):2641-4.

6) Soriano ER, Rosa J, Velozo E, et al. Incidence and prevalence of psoriatic arthritis in Buenos Aires, Argentina:a 6-year health management organization-based study. Rheumatology (Oxford) 2011;50(4):729-34.

7) Shbeeb M, Uramoto KM, Gibson LE, et al. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol 2000;27(5):1247-50.

8) Söderlin MK, Börjesson O, Kautiainen H, et al. Annual incidence of inflammatory joint diseases in a population based study in southern Sweden. Ann Rheum Dis 2002;61(10):911-5.

9) Savolainen E, Kaipiainen-Seppänen O, Kröger L, et al. Total incidence and distribution of inflammatory joint diseases in a defined population:results from the Kuopio 2000 arthritis survey. J Rheumatol 2003;30(11):2460-8.

10) 日本脊椎関節炎学会 厚生労働科学研究費補助金(難治性疾患政策研究事業)「強直性脊椎炎に代表される脊椎関節炎の疫学調査・診断基準作成と診療ガイドライン策定を目指した大規模多施設研究」班(編)．脊椎関節炎診療の手引き2020．東京：診断と治療社；2020．

11) Wilson FC, Icen M, Crowson CS, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis:a population-based study. Arthritis Rheum 2009;61(2):233-9.

12) Chandran V, Schentag CT, Brockbank JE, et al. Familial aggregation of psoriatic arthritis. Ann Rheum Dis 2009;68(5):664-7.

13) Haroon M, Winchester R, Giles JT, et al. Certain class I HLA alleles and haplotypes implicated in susceptibility play a role in determining specific features of the psoriatic arthritis phenotype. Ann Rheum Dis 2016;75(1):155-62.

14) Eder L, Chandran V, Pellett F, et al. Differential human leucocyte allele association between psoriasis and psoriatic arthritis:a family-based association study. Ann Rheum Dis 2012;71(8):1361-5.

15) Wada T, Kanno A, Izawa N, et al. Comparison of clinical features between the patients with axial and peripheral spondyloarthritis. Mod Rheumatol 2021;31 (suppl 64).

16) Bowes J, Loehr S, Budu-Aggrey A, et al. PTPN22 is associated with susceptibility to psoriatic arthritis but not psoriasis:evidence for a further PsA-specific risk locus. Ann Rheum Dis 2015;74(10):1882-5.

17) Stuart PE, Nair RP, Tsoi LC, et al. Genome-wide association analysis of psoriatic arthritis and cutaneous psoriasis reveals differences in their genetic architecture. Am J Hum Genet 2015;97(6):816-3.

18) Bowes J, Budu-Aggrey A, Huffmeier U, et al. Dense genotyping of immune-related susceptibility loci reveals new insights into the genetics of psoriatic arthritis. Nat Commun 2015;6:6046. doi:10.1038/ncomms7046.

19) McGonagle D, Tan AL, Benjamin M. The nail as a musculoskeletal appendage--implications for an improved understanding of the link between psoriasis and arthritis. Dermatology 2009;218(2):97-102.

20) McGonagle D, Marzo-Ortega H, Benjamin M, et al. Report on the Second international Enthesitis Workshop. Arthritis Rheum 2003;48(4):896-905.

21) Sherlock JP, Joyce-Shaikh B, Turner SP, et al. IL-23 induces spondyloarthropathy by acting on ROR-γt＋CD3＋CD4-CD8- entheseal resident T cells. Nat Med 2012;18(7):1069-76.

22) Reinhardt A, Yevsa T, Worbs T, et al. Interleukin-23-dependent γ/δ T cells produce interleukin-17 and accumulate in the enthesis, aortic valve, and ciliary body in mice. Arthritis Rheumatol 2016;68(10):2476-86.

23) Cuthbert RJ, Fragkakis EM, Dunsmuir R, et al. Brief report:group 3 innate lymphoid cells in human enthesis. Arthritis Rheumatol 2017;69(9):1816-22.

24) Soare A, Weber S, Maul L, et al. Cutting edge:homeostasis of innate lymphoid cells is imbalanced in psoriatic arthritis. J Immunol 2018;200(4):1249-54.

25) Chizzolini C, Chicheportiche R, Alvarez M, et al. Prostaglandin E2 synergistically with interleukin-23 favors human Th17 expansion. Blood 2008;112(9):3696-703.

26) Paulissen SM, van Hamburg JP, Davelaar N, et al. Synovial fibroblasts directly induce Th17 pathogenicity via the cyclooxygenase/prostaglandin E2 pathway, independent of IL-23. J Immunol 2013;191(3):1364-72.

27) Raychaudhuri SP, Raychaudhuri SK, Genovese MC. IL-17 receptor and its functional significance in psoriatic arthritis. Mol Cell Biochem 2012;359(1-2):419-29.

28) Millar NL, Akbar M, Campbell AL, et al. IL-17A mediates inflammatory and tissue remodelling events in early human tendinopathy. Sci Rep 2016;6:27149. doi:10.1038/srep27149.

29) Ono T, Okamoto K, Nakashima T, et al. IL-17-producing γδ T cells enhance bone regeneration. Nat Commun 2016;7:10928. doi:10.1038/ncomms10928.

30) El-Zayadi AA, Jones EA, Churchman SM, et al. Interleukin-22 drives the proliferation, migration and osteogenic differentiation of mesenchymal stem cells:a novel cytokine that could contribute to new bone formation in spondyloarthropathies. Rheumatology (Oxford) 2017;56(3):488-93.

31) Ritchlin CT, Haas-Smith SA, Li P, et al. Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest 2003;111(6):821-31.

32) Schett G, Rahman P, Ritchlin C, et al. Psoriatic arthritis from a mechanistic perspective. Nat Rev Rheumatol 2022;18(6):311-25.

33) Adamopoulos IE, Chao CC, Geissler R, et al. Interleukin-17A upregulates receptor activator of NF-kappaB on osteoclast precursors. Arthritis Res Ther 2010;12(1):R29. doi:10.1186/ar2936.

34) McInnes IB, Anderson JK, Magrey M, et al. Trial of upadacitinib and adalimumab for psoriatic arthritis. N Engl J Med 2021;384(13):1227-39.

35) Fiocco U, Martini V, Accordi B, et al. Transcriptional network profile on synovial fluid T cells in psoriatic arthritis. Clin Rheumatol 2015;34(9):1571-80.

36) O'Brien A, Hanlon MM, Marzaioli V, et al. Targeting JAK-STAT signalling alters PsA synovial fibroblast pro-inflammatory and metabolic function. Front Immunol 2021;12:672461. doi:10.3389/fimmu.2021.672461.

37) Scher JU, Ogdie A, Merola JF, et al. Preventing psoriatic arthritis:focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol 2019;15(3):153-66.

38) Eder L, Jayakar J, Pollock R, et al. Serum adipokines in patients with psoriatic arthritis and psoriasis alone and their correlation with disease activity. Ann Rheum Dis 2013;72(12):1956-61.

39) Caso F, Postiglione L, Covelli B, et al. Pro-inflammatory adipokine profile in psoriatic arthritis:results from a cross-sectional study comparing PsA subset with evident cutaneous involvement and subset “sine psoriasis”. Clin Rheumatol 2019;38(9):2547-52.

40) Cheleschi S, Tenti S, Bedogni G, et al. Circulating Mir-140 and leptin improve the accuracy of the differential diagnosis between psoriatic arthritis and rheumatoid arthritis:a case-control study. Transl Res 2022;239:18-34.

41) Tateya S, Kim F, Tamori Y. Recent advances in obesity-induced inflammation and insulin resistance. Front Endocrinol (Lausanne) 2013;4:93. doi:10.3389/fendo.2013.00093.

42) Boehncke WH. Systemic inflammation and cardiovascular comorbidity in psoriasis patients:causes and consequences. Front Immunol 2018;9:579. doi:10.3389/fimmu.2018.00579.

43) Gupta S, Syrimi Z, Hughes DM, et al. Comorbidities in psoriatic arthritis:a systematic review and meta-analysis. Rheumatol Int 2021;41(2):275-84.

44) Wada T, Asanuma YF, Okabe Y, et al. Cardiovascular risk assessment in patients with psoriatic arhtirits (PsA) [abstract]. Mod Rheumatol 2023;33 (suppl):S162.

45) Polachek A, Touma Z, Anderson M, et al. Risk of cardiovascular morbidity in patients with psoriatic arthritis:a meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2017;69(1):67-74.

46) Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies:2019 update. Ann Rheum Dis 2020;79(6):700-12.