Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies
Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies
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DOI：
10.3899/jrheum.140411
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发表时间：
2014-11-01
影响因子：
3.9
通讯作者：
Ritchlin, Christopher T.
中科院分区：
文献类型：
--
作者：
Anandarajah, Allen;Thiele, Ralf;Ritchlin, Christopher T.
目标。本研究的目的是验证在符合缓解标准的类风湿性关节炎（RA）患者中观察到的滑膜炎在磁共振成像（MRI）和超声（US）上反映了组织病理学上的活动性炎症的假设。根据美国风湿病学会的标准，我们分析了14例临床缓解的RA患者在手术过程中获得的15个滑膜标本。组织学标本被评分为滑膜衬里和滑膜间质增生，炎症，淋巴滤泡和血管。组织学评分分为轻微、轻度、中度和严重疾病活动度。在4个月的手术期间进行US和MRI对疾病活动性进行评分。检查组织学和影像学评分之间的相关性。14例患者中4例接受抗肿瘤坏死因子（TNF）治疗，4例单独接受甲氨蝶呤（MTX）治疗，4例联合羟氯喹（HCQ）治疗，1例联合羟氯喹（HCQ）治疗。4个标本在组织学上有严重、中度、轻度和轻度疾病活动。在接受抗肿瘤坏死因子治疗的受试者中观察到的4个标本中有3个具有微小和轻微的组织学。80%的关节有滑膜炎，60%的关节有多普勒信号。MRI显示86%的图像显示滑膜炎和骨髓水肿。组织学和滑膜炎评分之间存在正相关，但不显著相关。尽管临床缓解，组织学和影像学研究记录了持续活跃的疾病状态，这可能解释了放射学进展的机制。
Objective. The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology.Methods. We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined.Results. Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US.Conclusion. Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.