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Clinical significance of synovial lymphoid neogenesis and its reversal after anti-tumour necrosis factor α therapy in rheumatoid arthritis
  1. J D Cañete1,
  2. R Celis1,
  3. C Moll1,
  4. E Izquierdo3,
  5. S Marsal6,
  6. R Sanmartí1,
  7. A Palacín2,
  8. D Lora4,
  9. J de la Cruz5,
  10. J L Pablos3
  1. 1
    Unitat d’Artritis, Servei de Reumatologia, Hospital Clínic de Barcelona, Barcelona, Spain
  2. 2
    Servei de Anatomía Patológica, Hospital Clínic de Barcelona and Institut d’Investigacions Biomèdiques August Pí i Sunyer, Barcelona, Spain
  3. 3
    Unidad de Investigación, Servicio de Reumatología Hospital 12 de Octubre, Madrid, Spain
  4. 4
    Unidad de Epidemiología Clínica Hospital 12 de Octubre, Madrid, Spain
  5. 5
    CIBER Epidemiología y Salud Pública (CIBERESP), Hospital 12 de Octubre, Madrid, Spain
  6. 6
    Unitat de Recerca de Reumatologia, Institut de Recerca Hospital Universitari Vall d’Hebron, Barcelona, Spain
  1. J D Cañete, Unitat d’Artritis, Servei de Reumatología, Hospital Clínic de Barcelona, c/Villarroel, 170, 08036 Barcelona, Spain; jcanete{at}


Objective: To investigate the clinical significance of lymphoid neogenesis (LN) in rheumatoid arthritis (RA), the clinicopathological correlates of this process and its evolution after anti-tumour necrosis factor (TNF)α therapy in a large series of synovial tissues were analysed.

Methods: Arthroscopic synovial biopsies from 86 patients with RA were analysed by immunohistochemistry. LN was defined as the presence of large aggregates of lymphocytes with T/B cell compartmentalisation and peripheral node addressin (PNAd) positive high endothelial venules. Clinical variables at baseline and after prospective follow-up were compared in LN positive and negative RA subsets. The evolution of LN and its correlation with the clinical course in a subgroup of 24 patients that underwent a second arthroscopic biopsy after anti-TNFα therapy was also analysed.

Results: LN was present in 49% of RA synovial tissues. Patients with LN had a significantly higher disease duration and a higher previous use of anti-TNFα agents. During prospective follow-up, the proportion of patients achieving good or moderate European League Against Rheumatism (EULAR) 28-joint Disease Activity Score (DAS28) responses was significantly lower in patients who were LN positive despite a significantly higher use of anti-TNFα agents. By multivariate logistic regression analysis, LN remained as an independent negative predictor of response to therapy. In the subgroup of patients rebiopsied after anti-TNFα therapy, reversal of LN features occurred in 56% of the patients and correlated with good clinical responses.

Conclusions: Synovial LN in RA predicts a lower response to therapy. LN features can be reversed after a short period of anti-TNFα therapy in parallel to good clinical responses.

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  • Competing interests: None.

  • Funding: This work was supported by the Fondo de Investigación Sanitaria, Ministerio de Sanidad y Consumo (FIS 04/1023, 04/1027 and 05/983 to JDC, and 05/60 to JLP) and by a grant from Fundación Española de Reumatología/Abbot Laboratories to JDC. CM was supported by a grant from Hospital Clínic de Barcelona, and EI by the predoctoral programme of the Fondo de Investigación Sanitaria.

  • Ethics approval: All patients signed an informed consent and the study was approved by the Ethical Committee of the Hospital Clinic of Barcelona.

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