Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment

Melicòni, Riccardo; Pulsatelli, Lia; Uguccioni, Mariagrazia; Salvarani, Carlo; Macchioni, Pierluigi; Melchiorri, Cinzia; Focherini, M. C.; Frizziero, L; Facchini, Andrea

doi:10.1002/art.1780390719

Cited by 110 publications

(76 citation statements)

References 24 publications

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“…With regard to the pathophysiology of PMR, the prevailing view today is that the symptoms of PMR are caused by inflammatory processes occurring in synovial structures (10,(12)(13)(14)(15)(16). However, imaging evidence of synovial inflammation does not entirely correlate with the clinical findings (2,13).…”

Section: Discussionmentioning

confidence: 99%

“…Based on the paucity of laboratory evidence of muscle and vascular abnormalities, as well as on the histologic, MRI, computed tomography, ultrasound, and FDG-PET evidence from the shoulder and hip joints (3,10,(12)(13)(14) and the spinal column (2,12), the predominant view has, in recent years, been that the symptoms in patients with PMR reflect bursitis and synovitis (12,15,16). However, PMR symptoms may be seen in the absence of imaging evidence of inflammation, and conversely, such evidence may be present in the absence of symptoms of PMR or may remain after such symptoms have disappeared (13,14).…”

mentioning

confidence: 99%

“…However, PMR symptoms may be seen in the absence of imaging evidence of inflammation, and conversely, such evidence may be present in the absence of symptoms of PMR or may remain after such symptoms have disappeared (13,14).…”

mentioning

confidence: 99%

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Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

Kreiner¹,

Langberg²,

Galbo³

2010

Arthritis & Rheumatism

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Objective. Polymyalgia rheumatica (PMR) is characterized by aching of the proximal muscles and increased blood levels of markers of inflammation. Despite the muscle complaints, the current view is that symptoms are caused by inflammation in synovial structures. The purpose of this study was to elucidate the disease mechanisms in symptomatic muscles by measuring interstitial levels of cytokines before and after prednisolone treatment.Methods. Twenty glucocorticoid-naive patients newly diagnosed as having PMR and 20 control subjects were studied before and after 14 days of prednisolone therapy (20 mg/day). Interstitial concentrations of interleukin-1␣/␤ (IL-1␣/␤), IL-1 receptor antagonist, IL-6, IL-8, tumor necrosis factor ␣ (TNF␣), and monocyte chemoattractant protein 1 were measured in symptomatic vastus lateralis and trapezius muscles using the microdialysis technique. Plasma levels were measured simultaneously.Results. Prednisolone abolished symptoms in all of the PMR patients within 1-2 days; the erythrocyte sedimentation rate and C-reactive protein levels were normalized on day 14. In both muscles, interstitial concentrations of all cytokines were markedly higher (P < 0.05) in the PMR patients than in the controls before treatment. In both patients and controls, interstitial levels of most cytokines were higher than plasma levels, with the exception of IL-1␣ and TNF␣, which were lower in both groups. In the PMR patients, interstitial concentrations were normalized after prednisolone treatment.Conclusion. This study introduces a novel view of PMR, indicating that increased interstitial levels of inflammatory cytokines in symptomatic muscles play a role in the pathophysiology of the disease and that cytokines may be released locally. To explore the disease specificity, similar studies in other primary inflammatory conditions are warranted.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

Kreiner¹,

Langberg²,

Galbo³

2010

Arthritis & Rheumatism

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“…However, arthroscopic studies have confirmed the presence of synovitis in the proximal joints of PMR patients (8). Moreover, magnetic resonance imaging and ultrasonography have disclosed inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps, as well as the presence of trochanteric, iliopsoas, ischiogluteal, and low cervical interspace bursitis in patients with PMR (9 -12).…”

Section: Epidemiology Of Gca and Pmrmentioning

confidence: 99%

Epidemiology of giant cell arteritis and polymyalgia rheumatica

González-Gay¹,

Vázquez-Rodríguez²,

Lopez-Diaz³

et al. 2009

Arthritis & Rheumatism

503

286

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“…Although corticosteroids rapidly control PMR clinical manifestations, patients often require corticosteroid therapy for at least 2 years, with potential multiple side effects [1]. Synovitis is a major cause of musculoskeletal symptoms in PMR [2], but the pathomechanisms leading to synovial lesion are not well known.…”

Section: Introductionmentioning

confidence: 99%

Synovial expression of cell adhesion molecules in polymyalgia rheumatica

Melicòni

Pulsatelli

Melchiorri

et al. 1997

Clinical and Experimental Immunology

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SUMMARYPolymyalgia rheumatica (PMR) is a common disorder of the elderly: the pathogenesis of the syndrome is still debated, though active synovitis of the shoulder has recently been confirmed. To investigate the pathogenesis of this synovitis we evaluated cell adhesion molecule (CAM) expression in shoulder synovial tissue from patients with PMR, correlated synovial expression with the serum levels of soluble forms, and assessed the changes associated with corticosteroid treatment. Arthroscopic synovial biopsies were obtained from 12 untreated and seven corticosteroid (CS)-treated cases. CAM expression was evaluated by MoAb staining on frozen sections and computerized image analysis. Soluble CAM were quantified by ELISA. Endothelial cells expressed intercellular adhesion molecule-1 (ICAM-l), Eand P-selectins. Infiltrating cells were ICAM-1 and b 1 -integrin-positive, while L-selectin expression was limited to intravascular leucocytes. Synovial lining cells strongly expressed vascular cell adhesion molecule-1 (VCAM-1), and less intensely ICAM-1. Only the soluble form of ICAM-1 (sICAM-1) was elevated in untreated patients. CS treatment was associated with a decrease in ICAM-1, VCAM-1 and Eand P-selectin expression. sICAM-1 levels were in the normal range in treated patients. VLA-5 and 6 expression was widely distributed among cell types, and was not CS-sensitive. Active shoulder synovitis is associated with different CAM expression in PMR. ICAM-l expression is widely distributed and correlates with elevated levels of the soluble form; it is significantly lower in CS-treated asymptomatic cases.

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Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment

Cited by 110 publications

References 24 publications

Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

Epidemiology of giant cell arteritis and polymyalgia rheumatica

Synovial expression of cell adhesion molecules in polymyalgia rheumatica

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