[2009] [SAT0002] CHARACTERIZATION OF THE CELLULAR INFILTRATE OF LOCALIZED SCLERODERMA SKIN LESIONS BEFORE AND AFTER METHOTREXATE OR PREDNISONE TREATMENT
F. Lunardi1, B. Montini2, G. Martini2, F. La Torre2, F. Calabrese1, F. Zulian2 1Special Pathological Anatomy Unit, Department of Medical Diagnostic Sciences and Special Therapies; 2Department of Paediatrics, University of Padua, Padova, Italy
Background: Juvenile Localized Scleroderma (JLS) causes circumscribed thickening of the skin due to excessive collagen deposition. Immunological abnormalities may play an important role in its pathogenesis.
Objectives: To characterize the immunological features of the cell infiltrate in active JLS lesions and their changes after methotrexate (MTX) or prednisone (PDN) treatment.
Methods: We analyzed the skin biopsy from children with JLS in active phase at baseline and after 12 months of treatment with: Prednisone (PDN) (1 mg/kg/die) for 3 months, then Placebo for 9 months (Group A) or MTX (15 mg/m2/week) + PDN (1 mg/kg/die) for 3 months then just MTX for 9 months (Group B). The samples were analyzed by immunohistochemistry and morphometry using monoclonal antibodies against CD45 (all leucocytes), CD3 (T lymphocytes), CD4 (T-helper cells), CD8 (cytotoxic/suppressor T cells), CD20 (B lymphocytes). Data are expressed as positive cell number/mm2 of tissue (mean ± standard deviation).
Results: 22 children with JLS (10 in Group A and 12 in Group B) were included in the study.
Active JLS skin lesions showed a significant increase of inflammatory cells (CD45: 193±114) constituted mainly by CD3 T cells (101±58). CD8+ was the prevalent T-lymphocyte population (77±59) while the CD4/CD8 ratio was 0,34. CD20+ B-cells, usually absent in normal skin, were found in 17/22 samples with a mean value of 28±54 cells/mm2.
Iterative skin biopsy, after 12 months of MTX treatment (Group B), showed a significant decrease of the inflammatory infiltrate with CD45 decreased from 185±43 to 66±37, p=0.01), CD3+ cells from 116±68 to 46±31, p=0.05, with inversion of the CD4/CD8 ratio from 0.12 to 3.23 and disappearance of the CD20+ B-cells (from 12±13 to 0.01, p=0.0001). The group of patients treated with PDN alone for 3 months (Group A), showed no significant changes from the baseline (CD45: from 233±75 to 150±20; CD3: from 77±11 to 49±37; CD8: from 55±21 to 40±36; CD4/CD8 ratio: from 0.07 to 0.05; CD20: from 16±11 to 17±24, all p=ns).
Conclusion: JLS active lesions are characterized by infiltration of CD8+ T cell and B cells, which seem to play an important role in the early phases of the disease. MTX treatment significantly reduces the inflammatory infiltrate, re-establish the CD4/CD8 T-cell ratio and induce the B-cell disappearance.
Disclosure of Interest: None declared
Ann Rheum Dis 2009;68(Suppl3):541
Basic Science in paediatric rheumatology
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