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  • Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?

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Clinical and epidemiological research
Extended report
Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?
  1. Stefano Alivernini1,
  2. Barbara Tolusso1,
  3. Luca Petricca1,
  4. Laura Bui2,
  5. Gabriele Di Sante1,
  6. Giusy Peluso1,
  7. Roberta Benvenuto2,
  8. Anna Laura Fedele1,
  9. Franco Federico2,
  10. Gianfranco Ferraccioli1,
  11. Elisa Gremese1
  1. 1 Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
  2. 2 Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
  1. Correspondence to Professor Gianfranco Ferraccioli, Professor of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario A. Gemelli—Catholic University of the Sacred Heart, Via Giuseppe Moscati, 31, Rome 00168, Italy; gianfranco.ferraccioli{at}unicatt.it

Abstract

Objective To define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockers.

Methods Patients with RA in remission (n=25) (disease activity score (DAS)<1.6 for at least 6 months), patients with RA in low disease activity (LDA) (n=10) (1.6<DAS<2.4 for at least 6 months) and patients with PsA in remission (n=18) (DAS<1.6 and Psoriasis Area Severity Index (PASI)=0 for at least 6 months) achieved by MTX+anti-TNF (adalimumab 40 mg or etanercept 50 mg) with power Doppler (PDUS)-negative synovial hypertrophy underwent synovial tissue biopsy. Patients with RA with high/moderate disease naïve to treatment (n=50) were included as a comparison group. Immunostaining for cluster designation (CD)68, CD21, CD20, CD3, CD31 and collagen was performed.

Results PDUS-negative patients with RA in remission showed lower histological scores for synovial CD68+, CD20+, CD3+ cells and CD31+ vessels and collagen deposition (p<0.05 for both lining and sublining) compared with PDUS-positive patients with RA with high/moderate disease. In addition, there was no significant difference in terms of lining and sublining CD68+, CD20+, CD3+, CD31+ cells and collagen comparing PDUS-negative patients with RA in remission and in LDA, respectively. On the contrary, PDUS-negative patients with PsA in remission showed higher histological scores for sublining CD68+ (p=0.02) and CD3+ cells (p=0.04) as well as CD31+ vessels (p<0.001) than PDUS-negative patients with RA in remission.

Conclusions PDUS-negative patients with RA in remission have comparable synovial histological features than PDUS-negative patients with RA in LDA. However, patients with PsA in remission are characterised by a higher degree of residual synovial inflammation than patients with RA in remission, despite PDUS negativity under TNF inhibition.

  • Rheumatoid Arthritis
  • Anti-TNF
  • Synovitis
  • Ultrasonography
  • Psoriatic Arthritis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/annrheumdis-2016-210424

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    Footnotes

    • Handling editor Tore K Kvien

    • Contributors SA, GF and EG gave substantial contributions to study conception and design; SA, BT, LP, LB, GDS, RB, GP, ALF and FF gave substantial contributions to acquisition of data; SA, BT GF and EG gave substantial contributions to analysis and interpretation of data; SA, BT, LP, LB, GDS, RB, GP, ALF, FF, GF and EG drafted the article and revised it critically for important intellectual content; SA, BT, LP, LB, GDS, RB, GP, ALF, FF, GF and EG gave final approval for the version of the article to be published.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Fondazione Policlinico Universitario A. Gemelli—Catholic University of the Sacred Heart Ethical Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.