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Effect of intra-articular infliximab on synovial membrane pathology in a patient with a seronegative spondyloarthropathy
  1. M J Ahern,
  2. D G Campbell,
  3. H Weedon,
  4. V Papangelis,
  5. M D Smith
  1. Rheumatology Research Unit, Repatriation General Hospital, South Australia
  1. Professor M D Smith, Repatriation General, Hospital, Daws Rd, Daw Park, 5041 South Australia; Malcolm.smith{at}rgh.sa.gov.au

Abstract

Objective: To demonstrate the efficacy of intra-articular infliximab in a patient with a persistent monarthritis who had previously had two arthroscopic synovectomies with limited success, and to determine the effect of intra-articular infliximab on synovial membrane pathology

Method: Arthroscopic synovial biopsy specimens were collected before and after treatment with intra-articular infliximab. The synovial tissue was stained for a range of inflammatory cell subsets, cell adhesion molecules and cytokines using immunohistochemical techniques and quantified using digital image analysis and a semiquantitative scoring method.

Results: Clinical improvement in the knee synovitis was seen after the first two intra-articular infliximab treatments, with a sustained clinical remission lasting for more than 12 months after the third treatment. Significant changes in cellular infiltration and expression of cytokines and cell adhesion molecules occurred as a result of treatment with intra-articular infliximab, with a reduction in some but not all cells in the inflammatory infiltrate, as well as a reduction in the expression of cell adhesion molecules (intercellular adhesion molecule-1 and vascular adhesion molecule-1) and production of cytokines (interleukin 1β and tumour necrosis factor α).

Conclusion: Intra-articular infliximab administration is a viable treatment for a persistent monarthritis resistant to other treatment options and can successfully modulate the inflammatory milieu within the synovial membrane.

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Footnotes

  • Funding: Supported by the Daw Park Research Foundation, National Health and Medical Research Council of Australia and the Arthritis Foundation of Australia.

  • Competing interests: None declared.

  • Ethics approval: Ethics committee approval obtained.

  • Patient consent: Obtained.

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