Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies

Journal of Rheumatology - Tập 41 Số 11 - Trang 2153-2160 - 2014
Allen Anandarajah1, Ralf Thiele2, Ellen Giampoli3, Johnny U. V. Monu4, Gwysuk Seo5, Changyong Feng6, Christopher T. Ritchlin7
1From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center
2 Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, #N#USA.
3 R. Thiele, MD
4 E. Giampoli, MD, Department of Pathology and Laboratory Medicine
5 J. Monu, MD, MSc
6 G-S. Seo, MD, Department of Musculoskeletal Radiology
7 C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry

Tóm tắt

Objective.The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology.Methods.We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined.Results.Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US.Conclusion.Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.

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Journal of Rheumatology

Tập 41 Số 11

2153-2160

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