Background Little is known regarding the association between ultrasound determined pathological synovial blood flow and synovial pathology in rheumatoid arthritis (RA).
Objectives To examine the association between colour Doppler ultrasound imaging and synovitis according to histopathology in patients with RA.
Methods 51 synovial sites from the small hand joints from 19 RA patients were evaluated by ultrasound colour Doppler and subsequently biopsied by needle arthroscopy. Association between ultrasound colour fraction and an overall synovitis score (1) and immunohistochemical stainings for CD3, CD68, Ki67 and von Willebrandt Factor were investigated (2;3) using repeated samples from the same patients. The overall synovitis score (total 0-9) assessed synovial hypertrophy (0-3), stromal proliferation (0-3) and cellular infiltration (0-3). Data was clustered within patients, thus a linear mixed model was applied for the statistical analysis. Parsimony in the statistical models was achieved omitting covariates from the model in the case of, what was judged, no statistical significance (P>0.1).
Results For the RA patients Doppler colour fraction showed an association with the overall synovitis score (Approximated Spearman, Appr.rho =0.43, P=0.002). The density of all immunohistochemical staining showed a significant association with Doppler colour fraction: von Willebrandt Factor (Appr.rho =0.49, P=0.01), CD68 (Appr.rho=0.49, P=0.0002,), Ki67 (Appr.rho =0.47, P=0.002) and CD3 (Appr.rho=0.66, P<0.0001).
Conclusions Colour Doppler activity significantly correlates with the extent of inflammation present in the synovium of RA patients. Absence of a detectable colour fraction does not rule out synovial pathology.
Acknowledgement Supported by unrestricted grants from Novo Nordisk and the Oak Foundation. B. Jørgensen for preparation of the synovial biopsies.
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Disclosure of Interest M. Andersen Employee of: Novo Nordisk A/S, K. Ellegaard: None Declared, J. Hebsgaard Shareholder of: Novo Nordisk A/S, Employee of: Novo Nordisk A/S, R. Christensen: None Declared, P. Kvist Shareholder of: Novo Nordisk A/S, Employee of: Novo Nordisk A/S, N. Vendel: None Declared, J. Rømer Shareholder of: Novo Nordisk A/S, Employee of: Novo Nordisk A/S, N. Søe: None Declared, H. Bliddal: None Declared
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