The diagnostic value of perivascular infiltrates in muscle biopsy specimens for the assessment of rheumatoid vasculitis

doi:10.1136/ard.57.2.114

Annals of the Rheumatic Diseases 1998;57:114-117; doi:10.1136/ard.57.2.114

Ann Rheum Dis 1998;57:114-117 ( February )

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The diagnostic value of perivascular infiltrates in muscle biopsy specimens for the assessment of rheumatoid vasculitis Alexandre E Voskuyl,^a Sjoerd G van Duinen,^b Aeilko H Zwinderman,^c Ferdinand C Breedveld,^a Johanna M W Hazes^a

^a Departments of Rheumatology, ^b Pathology, ^c and Medical Statistics, ^d University Hospital Leiden, Leiden, the Netherlands

Correspondence to: Dr A E Voskuyl, Department of Rheumatology, Room B-417, University Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, the Netherlands.

Accepted for publication 17 December 1997

OBJECTIVE $---$ To determine the diagnostic value of perivascular infiltrates (PVI) in randomly obtained muscle biopsy specimens for the assessmentof rheumatoid vasculitis(RV).
METHODS $---$ The number and size of PVIs, defined as the presence of mononuclear or polymorphonuclear cells around $>=$ 50% of the circumferenceof a vessel wall, as well as the presence of fibrinoid necrosiswere determined in frozen sections of muscle samples of RV patientswith histologically confirmed vasculitis in fixed muscle tissue(n=12). The findings were compared with those observed in frozensections of muscle biopsy specimens of rheumatoid arthritis (RA)patients not suspected of vasculitis (n=14) and patients withosteoarthritis (OA) (n=11). The presence of PVIs and of fibrinoidnecrosis were sought in four frozen sections of the muscle biopsyspecimen.
RESULTS $---$ PVIs were observed in 75% of the RV patients, which was significantly (p < 0.05) higher than the frequency found in RA (14%)or OA (18%) patients. PVIs with $>=$ three cell layers were foundin 67% of the RV patients and in none of the RA and OA patients(p < 0.05). Fibrinoid necrosis was found in least one of fourfrozen section in 33% of the RV patients. There was a good intra-observerand inter-observer concordance on the presence of fibrinoid necrosisand of PVIs with $>=$ three celllayers.
CONCLUSIONS $---$ The assessment of PVIs with $>=$ three cell layers in a muscle biopsy specimen is a specific and reliable test in discriminatingRV from RA without vasculitis. The demonstration in muscle ofPVIs with $>=$ three cell layers is more sensitive than that of fibrinoidnecrosis in the diagnosis ofRV.

Keywords: rheumatoid arthritis; vasculitis; diagnosis; histology; perivascular infiltrates

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