Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya31144Research ArticleClinical and immunological aspects of extracorporeal photochemotherapy for psoriasis and psoriatic arthritisMolochkovV A-Kil'diushevskiĭA V-MolochkovA V-KarzanovO Vdr_karzanov@mail.ruIakubovskaiaE S-FedulkinaV A-151020128410697410042020Copyright © 2012, Consilium Medicum2012Aim. To evaluate the clinical efficiency of extracorporeal photochemotherapy (EPCT) in the treatment of psoriasis (Ps) and Ps associated with psoriatic arthritis (PsA). Subjects and methods. Ninety-three patients with different forms of psoriasis were examined. A study group (SG) comprised 52 patients who were treated with EPCT; a control group (CG) included 41 patients. All the patients received pharmacotherapy generally accepted for these diseases. The SG patients were given additionally EPCT (the patient took 8-methoxypsoralen in a dose of 0.6 mg/kg 1.5-2 hours before the procedure). Mononuclear cells were isolated from the patients' blood in the intermittent-line mode on a Haemonetics MCS+ cell separator. The cell suspension was irradiated with ultraviolet light A (λ=320-400 nm) on a JULIA irradiator at 10-15 ml/min for 30 min and reinfused in the patient. The course of therapy consisted of 4 sessions performed on alternate days. Results. A varying positive effect was obtained in 49 (94%) SG patients; the mean PASI scores fell from 19.7±3.4 to 6.7±2.1 (p<0.05). The DAS reflecting the activity of PsA reduced on average from 3.35±0.7 to 2.16±0.5 (p<0.05), which corresponded to the change of PsA activity from moderate to weak. In CG, the positive effect was less pronounced in 27 (66%) patients, the PASI scores dropped on average from 19.2±3.7 to 12.2±3.1 (p<0.05), DAS in patients with PsA decreased from 3.24±0.8 to 2.95±0.7 (p<0.05). Conclusion. EPCT showed a high efficiency in patients with psoriasis and Ps associated with PsA; the immunological studies demonstrated the pathogenetic direction of the technique.psoriasispsoriatic arthritisextracorporeal photochemotherapyphotopheresisпсориазпсориатический артритэкстракорпоральная фотохимиотерапияфотоферез[Кожные и венерические болезни. Руководство для врачей. Под ред. Ю.К. Скрипкина. М: Медицина 2005.][Кожные и венерические болезни. Справочник. Под ред. О.Л. Иванова. М 2006.][Farber E.M., Nall L. Psoriasis in the tropics. Epidemiologic, genetic, clinical, and therapeutical aspects. Dermatol Clin 1994; 12: 805-816.][Sullivan-Whalen M., Gilleaudeau P. Psoriasis: Hope for the future. Nurs Clin North Am. 2007; 42 (3): 467-484.][Griffiths C.E., Barker J.N. Pathogenesis and clinical features of psoriasis. Lancet 2007; 370 (9583): 263-271.][Ricotti C., Kerdel F.A. Subacute annular generalized pustular psoriasis treated with etanercept and cyclosporine combination. J Drugs Dermatol 2007; 7: 738-740.][Moll J.M.H., Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973; 3: 55-78.][Пчелинцева А.О., Коротаева Т.В., Корсакова Ю.Л. и др. Эффективность и переносимость лефлуномида при псориатическом артрите. Рус мед журн 2006; 25: 1852-1858.][Shbeeb M., Uramoto K.M. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol 2000; 27: 1247-1250.][Ревматология: Клинические рекомендации. Под ред. Е.Л. Насонова. 2-е изд., испр. и доп. М: ГЭОТАР-Медиа 2010; 752.][Alenius G. M., Stenberg B., Stenlund H. et al. Inflammatory joint manifestations are prevalent in psoriasis: prevalence study of joint and axial involvement in psoriatic patients, and evaluation of a psoriatic and arthritic questionnaire J Rheumatol 2002; 29: 2577-2582.][Brandt J., Braun J. Anti-TNFA-alpha agents in the treatment of psoriatic arthritis. Expert Opin Biol Ther 2006; 6 (2): 99-107.][Ritchlin C. Pathogenesis of psoriatic arthritis. Curr Opin Rheum 2005; 17: 406-412.][Молочков В.А., Бадокин В.В. Псориаз и псориатический артрит. М 2007.][De Misa R.F., Azana J.M., Harto A. et al. Psoriatic arthritis: one year of treatment with extracorporeal photochemotherapy. J Am Acad Dermatol 1994; 30 (6): 1037-1038.][Vahlquist C., Larsson M., Ernerudh J. et al. Treatment of psoriatic arthritis with extracorporeal photochemotherapy and conventional psoralen-ultraviolet A irradiation. Arthritis Rheum 1996; 39: 1519-1523.][Vonderheid E.C., Kang C.A., Kadin M. et al. Extracorporeal photopheresis in psoriasis vulgaris: clinical and immunologic observations. J Am Acad Dermatol 1990; 23 (4): 703-712.][Wang S.Q., Setlow R., Berwick M. et al. Ultraviolet A and melanoma: a review. J Am Acad Dermatol 2001; 44 (5): 837-846.][Werner G.H., Jolles P. Immunostimulating agents: what next? A review of their present and potential medical applications. Eur J Immunol 1996; 242: 1-19.][Wilfert H., Honigsmann H., Steiner G. et al. Treatment of psoriatic arthritis by extracorporeal photochemotherapy. Br J Dermatol 1992; 127 (4): 448.][Kavanaugh A., Cassel S. Disease Activity Score. Сurr Rheumatol Rep 2005; 7: 195-200.][Gladman D.D., Antoni C., Mease P. et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 (suppl II); 14-17.]