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Rheumatology 2001; 40: 1243-1255
© 2001 British Society for Rheumatology

Original Papers

Association of clinical, radiological and synovial immunopathological responses to anti-rheumatic treatment in rheumatoid arthritis

A. R. Pettit, H. Weedon1, M. Ahern1, S. Zehntner, I. H. Frazer, J. Slavotinek1, V. Au1, M. D. Smith1 and R. Thomas

Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland 4102 and
1 Rheumatology Research Unit, Repatriation General Hospital, Adelaide, South Australia 5041, Australia

Objectives. To compare immunohistochemical scoring with clinical scoring and radiology for the assessment of rheumatoid arthritis (RA) disease activity, synovial tissue (ST) biopsied arthroscopically was assessed from 18 patients before and after commencement of disease-modifying anti-rheumatic drug (DMARD) therapy.

Methods. Lymphocytes, macrophages, differentiated dendritic cells (DC), vascularity, tumour necrosis factor (TNF) {alpha} and interleukin-1ß levels were scored. Clinical status was scored using the American College of Rheumatology (ACR) core set and serial radiographs were scored using the Larsen and Sharp methods. Histopathological evidence of activity included infiltration by lymphocytes, DC, macrophages, tissue vascularity, and expression of lining and sublining TNF{alpha}. These indices co-varied across the set of ST biopsies and were combined as a synovial activity score for each biopsy.

Results. The change in synovial activity with treatment correlated with the ACR clinical response and with decreased radiological progression by the Larsen score. The ACR response to DMARD therapy, the change in synovial activity score and the slowing of radiological progression were each greatest in patients with high initial synovial vascularity.

Conclusions. The data demonstrate an association between clinical, radiological and synovial immunopathological responses to anti-rheumatic treatment in RA. High ST vascularity may predict favourable clinical and radiological responses to treatment.

KEY WORDS: Rheumatoid arthritis, Synovial vascularity, DMARD therapy.

Correspondence to: R. Thomas.


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