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The synovitis of “non-inflammatory” orthopaedic arthropathies: a quantitative histological and immunohistochemical analysis
  1. F Pessler1,7,
  2. L Dai2,8,
  3. C Diaz-Torne3,9,
  4. C Gomez-Vaquero4,
  5. M E Paessler5,
  6. D-H Zheng2,
  7. E Einhorn6,
  8. U Range7,
  9. C Scanzello8,
  10. H R Schumacher9,10
  1. 1
    The Children’s Hospital of Philadelphia, Division of Rheumatology, Philadelphia, USA
  2. 2
    Second Affiliated Hospital, Division of Rheumatology, Sun Yat-sen University, Guangzhou, China
  3. 3
    Hospital de la Santa Creu I Sant Pau, Unit of Rheumatology, Barcelona, Spain
  4. 4
    Hospital Universitari de Bellvitge, Division of Rheumatology, Barcelona, Spain
  5. 5
    The Children’s Hospital of Philadelphia, Department of Pathology, Philadelphia, USA
  6. 6
    Department of Pathology, Philadelphia VA Medical Center, Philadelphia, USA
  7. 7
    Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Germany
  8. 8
    Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
  9. 9
    University of Pennsylvania School of Medicine, Division of Rheumatology, Pennsylvania, USA
  10. 10
    Division of Rheumatology, Philadelphia VA Medical Center, Philadelphia, USA
  1. Dr F Pessler, Klinik und Poliklinik für Kinder- und Jugendmedizin, Medizinische Fakultät Carl-Gustav-Carus, Technische Universität Dresden, Fetscherstr 74, 01307 Dresden, Germany; frank.pessler{at}


Objective: To quantify inflammatory changes in synovial membranes from orthopaedic “non-inflammatory” arthropathies (Orth. A).

Methods: Synovial membranes from patients with femur fracture, avascular necrosis of the femur, plica syndrome, and meniscus and/or ligament injury (n = 23); rheumatoid arthritis (n = 28); osteoarthritis (OA; n = 25); and from normal controls (n = 10) were assessed by light microscopy, a histological synovitis score, immunostaining for CD3, CD20, CD38, CD68, Ki-67 and von Willebrand factor, and with an immunohistochemical inflammation score.

Results: Orth. A histology varied between normal and markedly inflamed. Predominant abnormalities were mild lining hyperplasia, scattered inflammatory cells and small perivascular infiltrates. The synovitis score classified Orth. A as “mild synovitis”. Inflammatory cells occurred frequently: CD68+ cells in 100% of Orth. A specimens; CD3+, 91%; CD38+, 70%; and CD20+, 39%. Orth. A had 36% greater lining thickness (p = 0.04), 40% higher vascular density (p = 0.009) and 51.3-fold higher CD38+ cell density (p = 0.02) than normal controls; and 60% fewer subintimal Ki-67+ cells (p = 0.003), 42% fewer CD68+ lining cells (p<0.01) and 40% fewer subintimal CD68+ cells (p<0.01) than OA. The immunohistochemical inflammation score was 2.2-fold higher in Orth. A than in controls (p = 0.048) and similar to OA, with three Orth. A specimens showing marked inflammation.

Conclusions: Synovial membranes from “non-inflammatory” arthropathies featured neovascularisation and inflammation intermediate between normal and OA synovium. These results expand previous findings that mechanical joint injury may lead to a mild-to-moderate synovitis.

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  • Funding: FP was supported by National Institutes of Health Training Grants T32-AR 007442 and T32-CA 09140.

  • Competing interests: None.

  • Ethics approval: Approved by the institutional review boards of the Philadelphia VA Medical Center.

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