Background Antibodies to cyclic citrullinated peptide (anti-CCP) are valuable immunological marker for early diagnostic of rheumatoid arthritis (RA). They are highly sensitive and highly specific in RA. In addition, anti-CCP used as prognostic marker of severe RA. Arthroscopy is a minimally invasive technique, safe and efficient for visualization and biopsy of synovia (S) in rheumatology. Changes and structure of S are different for stages of RA. Detailed study of S changes features depending on the RA clinical course is an actual problem in rheumatology, as it allows early diagnostic of the disease, clinical course prognosis and individual therapy prescription.
Objectives to define a peculiarities of S macro-assessment on arthroscopy in RA patients depending on the blood level of anti-CCP
Methods knee arthroscopy was performed in 33 patients with RA (diagnosis is verified according to the criteria ACR/EULAR, 2010). Patients were divided into two groups depending on the blood level of anti-CCP. The first group (“−” anti-CCP), with negative or low positive level, included 13 patients (40%) (anti-CCP level was ≤40 IU/ml). The second group (“+” anti-CCP) positive and highly positive - 20 patients (60%) (anti-CCP level was >40 IU/ml). The patients of the two groups were not statistically different for clinical and demographic indicators.
All arthroscopy was performed in the same sterile operating room via arthroscope (Karl Storz GmbH, Tuttlingen, Germany) of 2.4 mm with an angle of 30°. Arthroscopy was performed in accordance with Helsinki Declaration. All chambers of the joint were inspected. The joint lavage for visualization was perfomed throughout the procedure, but minimized (usually it is about 500 to 1000 ml). All the arthroscopy procedure was recorded on video for the further evaluation of the macroscopic picture of the knee joint changes. Parameters of the changes were estimated: the type of S hyperplasia, S vascularization, atrophic changes in S, presence of pannus and fibrin, shape of S villi
Results Indices of inflammatory and of villous S hyperplasia were equally often (62% and 76%, 69% and 75%, respectively) in the patients of the two examined groups. S hyperemia and expressed vascular pattern predominated in “+” anti-CCP group of the patients - 76% of cases, compared with the group “−” anti-CCP - 36% (χ2=4.17, p=0.04). Growth of S with clavate villi tended to increase in the patients of “+” anti-CCP group. Presence of pannus significantly prevalent in patients with “+” anti-CCP group (75%) when compared with “−” anti-CCP groups - 31% (χ2=4.63, p=0.03). The presence of fibrin tended to increase in incidence in patients of “+” anti-CCP, but it was not statistically significant. The percentage of patients with atrophic changes of S was practically the same in the compared groups.
Conclusions RA patients with anti-CCP blood level of >40 IU/ml have S hyperemia with increased vascular pattern twice more often, and the presence of pannus on S arthroscopy was 2.5 times more often in them. The data shows the intensity of inflammation and angiogenesis in S of high anti-CCP blood level patients. This contributes to an aggressive course of RA in these patients with the rapid development of cartillage-bone destruction
Disclosure of Interest None declared