Absence of histologic evidence of synovitis in patients with Gulf War veterans' illness with joint pain
Absence of histologic evidence of synovitis in patients with Gulf War veterans' illness with joint pain
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DOI：
10.1002/art.23006
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发表时间：
2007-10-15
期刊：
影响因子：
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通讯作者：
Pessler, F.
中科院分区：
文献类型：
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作者：
Diaz-Torne, C.;Schumacher, H. R.;Pessler, F.
Objective.海湾战争退伍军人病（GWVI）是一种无法解释的多症状疾病，在第一次海湾战争（1990-1991）的盟军退伍军人中被描述。它已被提出，它的一些症状反映了免疫功能障碍，和风湿性症状，包括关节疼痛和僵硬的报告频繁。然而，目前尚不清楚滑膜炎症是否会导致关节症状。我们检查了GWVI和关节疼痛患者的滑膜组织，以寻找炎症证据。我们比较了来自6名GWVI和关节疼痛患者的滑膜活检样本与来自9名临床无症状对照的样本（仅苏木精和伊红[H&E]染色）以及来自10名类风湿性关节炎（RA）和12名骨关节炎（OA）患者的活检样本或手术获得的标本。在H&E染色切片中，通过免疫染色CD 3、CD 20、CD 38、CD 68、Ki-67和von Willebrand因子，采用改良的滑膜炎评分，以及基于这些标记物的复合炎症评分，对炎症变化进行定量。GWVI标本中观察到正常组织学，除了各1例标本中的轻度局灶性衬里增生和罕见的低度血管周围浸润。对照组（1.38 +/- 0.30）和GWVI样本（1.41 +/- 0.29）的平均SEM滑膜炎评分最低且几乎相同，OA样本居中（2.64 +/- 0.39），RA样本最高（6.0 +/- 0.19）。同样地，炎症细胞、细胞分裂、血管密度和复合炎症评分在GWVI患者中最低。尽管有显著的关节疼痛，GWVI滑膜与正常对照组没有差异。这些结果与其他未能证明GWVI炎症或免疫病因的研究一致。
Objective. An unexplained multisymptom illness, Gulf War veterans' illness (GWVI), has been described among allied force veterans of the first Gulf War (1990-1991). It has been proposed that some of its symptoms reflect an immune dysfunction, and rheumatologic symptoms including joint pain and stiffness are reported frequently. However, it is unknown whether synovial inflammation causes the articular symptoms. We examined synovial tissue from individuals with GWVI and joint pain for evidence of inflammation.Methods. We compared synovial biopsy samples from 6 individuals with GWVI and joint pain with samples from 9 clinically asymptomatic controls (hematoxylin and eosin [H&E] stains only) and biopsy samples or surgically obtained specimens from 10 patients with rheumatoid arthritis (RA) and 12 with osteoarthritis (OA). Inflammatory changes were quantified in H&E stained sections with a modified synovitis score by immunostaining for CD3, CD20, CD38, CD68, Ki-67, and von Willebrand factor, and with a composite inflammation score based on these markers.Results. Normal histology was seen in the GWVI specimens, except for mild focal lining hyperplasia and rare low-grade perivascular infiltrates in 1 specimen each. Mean SEM synovitis scores were lowest and nearly identical in control (1.38 +/- 0.30) and GWVI specimens (1.41 +/- 0.29), intermediate in OA specimens (2.64 +/- 0.39), and highest in RA specimens (6.0 +/- 0.19). Likewise, inflammatory cells, cell division, vascular density, and composite inflammation score were lowest in the GWVI specimens.Conclusion. Despite significant joint pain, the GWVI synovia did not differ from normal controls. These results agree with other studies that have failed to document inflammatory or immunologic etiologies in GWVI.