Effect of Narrow Band UVB Therapy and Methotrexate Treatment on Serum Adenosine Deaminase Enzyme Level in Severe Psoriasis Vulgaris Patients

Abstract

Abstract Background Psoriasis is a common, chronic inflammatory disease effects mainly skin, nails and joints. Adenosine deaminase (ADA) is an enzyme involved in purine metabolism and it is essential for the breakdown of adenosine from food and the turnover of nucleic acids in tissue. ADA possess a pivotal role in function and maturation of lymphoid cells, especially T-cell lineage, and its altered status was reported in diseases with immunological disturbances as in psoriasis. Moreover, ADA regulates the plasma adenosine level, which is involved in synthesis of inflammatory molecules and cytokine production. Increased ADA may be also due to increased nucleic acid catabolism associated with the hyperproliferative status of epidermis in psoriasis patients. Aim of the Study To measure serum level of adenosine deaminase enzyme by modified Guisti procedures in severe psoriasis vulgaris patients before and after treatment with narrow band ultraviolet B therapy and intramuscular methotrexate injection or combination of both and compare it with healthy controls. Subjects and Methods The present study included 45 severe psoriasis vulgaris patients and 15 apparent healthy age and sex matched controls. The study was approved by the Research Ethical Committee, Faculty of Medicine, Ain Shams University and fulfilled all the ethical aspects required in human research. All patients received full information about description of the procedure of treatment, possible side effects, photo documentation and they all provided informed consent. Results The current study revealed significant decrease in disease severity after treatment in all 3 groups with decreased PASI score. Serum ADA was significantly higher in patients groups compared to controls. Moreover, significant reduction of serum ADA was detected after treatment in all three groups being higher in combined MTX and NBUVB group. However, no significant correlation was detected between serum ADA levels and PASI scores before and after treatment. Conclusion We concluded that Adenosine deaminase possesses a significant role in the pathogenesis of psoriasis. Measurement of serum ADA level could be used as both diagnostic and prognostic marker for psoriasis and monitoring progress of treatment.