Comparative study of the synovial histology in rheumatoid arthritis, spondyloarthropathy, and osteoarthritis: influence of disease duration and activity

Abstract

Objectives-To compare the macroscopic and microscopic characteristics of synovial tissue in rheumatoid arthritis (RA), spondyloarthropathy (SpA), and osteoarthritis (OA) after exclusion of possible biases induced by disease duration or activity, or both. Methods-Synovial biopsy specimens were obtained by needle arthroscopy in patients with early RA (n=16), late RA (n=14), early SpA (n=23), and OA (n=12). Macroscopic and microscopic features were scored on a four point scale and analysed as a function of disease duration (early versus late RA), local and systemic disease activity, and diagnosis. Results-Except for the maximal synovial lining thickness, no significant diVerences were seen between early and late RA. For disease activity, synovial histology was only weakly correlated with C reactive protein in RA, but seemed to be strongly dependent on eVusion of the biopsied joint in all disease groups. After stratification for local disease activity, no disease related diVerences were found in patients without joint eVusion. In contrast, important diVerences were found between patients with RA and SpA with active joint eVusion. Synovial vascularity was macroscopically increased in SpA versus RA (p=0.017). A straight vessel pattern was only seen in RA, while tortuous vessels were preferentially seen in SpA. Vascularity was also microscopically increased in SpA compared with RA (p=0.031), and correlated with the macroscopic vascularity (r s =0.36, p=0.036). CD3+ (p=0.008), CD4+ (p=0.008), and CD20+ (p=0.024) lymphocytes were overrepresented in RA compared with SpA. The integrin expression in RA was characterised by a decrease of V 3 in the synovial lining (p=0.006) and an increase of V 5 in the sublining (p<0.001). Conclusions-The immune architecture of the synovial membrane is more dependent on local disease activity than on disease duration. Synovium obtained from clinically aVected joints shows important histological diVerences between RA and SpA.(Ann Rheum Dis 2000;59:945-953)

Endogenous HLA–DR–restricted presentation of the cartilage antigens human cartilage gp‐39 and melanoma inhibitory activity in the inflamed rheumatoid joint

“…Previously we demonstrated that HC gp-39 is not expressed exclusively in articular cartilage but is found also in inflamed synovium and that the synovial membrane is a privileged site for presentation of this protein to the immune system (6,14,19). In immunohistochemistry analyses for MIA in the present study, collected biopsies described previously (14,19,29,33) were used to investigate local expression of MIA in the synovium, with mAb 14A.…”

“…Additional SF samples from RA, SpA, and osteoarthritis (OA) patients originated from a previous study (28). Synovial membrane biopsy specimens from another group of patients (described in previous reports [14,19,29]) were obtained for immunohistochemistry studies. Eight biopsy samples per patient (17 RA, 13 SpA, 6 OA), obtained from an inflamed knee joint by needle arthroscopy (30), were studied.…”

“…For immunohistochemistry, the ST sections were blocked with 10% normal human serum and incubated overnight with mAb 14A (1 g/ml). Staining was performed as described previously (14,19,29,33), using an LSABϩ kit according to the instructions of the manufacturer (DakoCytomation, Glostrup, Denmark). Parallel sections were incubated with concentration-and isotype-matched irrelevant antibody (Dako Cytomation) as a negative control.…”

Alterations of the synovial T cell repertoire in anti–citrullinated protein antibody–positive rheumatoid arthritis

“…Synovial tissue biopsy samples were processed and evaluated for lining layer thickness, vascularity, global inflammatory infiltration, and lymphoid aggregates, as described previously (35)(36)(37). Synovial tissues from the 158 RA patients were divided into 2 groups.…”

Spondylarthritis in the absence of B lymphocytes

“…Dominique Baeten, 1 Elli Kruithof, 2 Maxime Breban, 3 and Paul P. Tak Spondylarthritis (SpA) is a major form of chronic inflammatory arthritis affecting both the peripheral joints and the axial skeleton. Despite clear differences in genetic background, demographic distribution, and pattern of joint inflammation between SpA and rheumatoid arthritis (RA), many of the drugs and strategies for the treatment of SpA have been translated from the RA field.…”