Rheumatology Advance Access originally published online on February 20, 2006
Rheumatology 2006 45(8):966-971; doi:10.1093/rheumatology/kel043
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Synovial vascular patterns and angiogenic factors expression in synovial tissue and serum of patients with rheumatoid arthritis
Arthritis Unit, Rheumatology Department, Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain.
Correspondence to: J. D. Cañete, Arthritis Unit, Rheumatology Department, Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain. E-mail: jcanete{at}clinic.ub.es
Objective. To determine whether subgroups of rheumatoid arthritis (RA) patients classified according to their synovial vascular pattern have a different expression of angiogenic mediators or exhibit distinct clinical or biological characteristics.
Methods. Arthroscopies were performed in 27 patients with RA and synovial samples were obtained. Vascular morphology was classified in three patterns: straight (S), tortuous (T) and mixed (M). Immunostaining was performed with anti-vascular endothelial growth factor (anti-VEGF), anti-vascular endothelial growth factor receptor (VEGFR)-1, anti-VEGFR-2, anti-IL-8 and anti-TGF-ß, and measured by digital image analysis. Serum levels of VEGF, TGF-ß and IL-8, and clinical, radiographic and serological data were also analysed.
Results. Eleven (41%) patients had the S pattern, nine (33%) the M pattern and seven (26%) the T pattern. The S and M groups had a higher prevalence of rheumatoid factor positivity and erosive disease, and higher levels of markers of systemic inflammation compared with the T group. Synovial expression of VEGF was higher in the S and T groups compared with the M group, whereas TGF-ß was higher in the T compared with the S and M groups. Distinct synovial distribution of VEGF and TGF-ß between groups was also observed.
Conclusions. This preliminary study suggests that RA patients with the S and M patterns share different clinical, biological and serological characteristics compared with those with the T pattern, which may constitute a group with less severe disease. Differences in the intensity and distribution of synovial expression of VEGF and TGF-ß observed between groups could have pathophysiological relevance. However, larger, prospective multicentre studies would be need to determine the clinical relevance of vascular patterns in RA.
KEY WORDS: Synovial tissue, Arthroscopy, Vascular pattern, Angiogenesis, Rheumatoid arthritis