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Quantitative Analysis of Immunohistologic Features of Very Early Rheumatoid Synovitis in Disease Modifying Antirheumatic Drug- and Corticosteroid-Naïve Patients

JASVINDER A. SINGH, JOSE A. PANDO, JOHN TOMASZEWSKI, and H. RALPH SCHUMACHER

ABSTRACT.

Objective.
To describe the immunohistochemical features of very early rheumatoid synovitis in disease modifying antirheumatic drug- and corticosteroid-naïve patients.

Methods. Eight patients presenting with oligoarthritis or polyarthritis, who later met American Rheumatism Association criteria for rheumatoid arthritis (RA), underwent needle synovial biopsies of a knee joint within the first 6 weeks after onset of disease symptoms. Using antibodies to CD3, CD8, L26, CD68, and von Willebrand factor, a detailed quantitative immunohistochemical analysis was done.

Results. CD3 T lymphocytes, CD8 T lymphocytes, L26 B lymphocytes, and CD68 macrophages were seen in 8/8 (100%), 7/8 (87%), 4/8 (50%), and 6/6 (100%) of synovial biopsies stained with the respective marker. There was a wide variation in number of positive cells between patients. CD3 and CD8 T cells were seen predominantly in perivascular areas, less often in a diffuse distribution, and not in aggregates. L26 B lymphocytes were found in much smaller numbers compared with T lymphocytes. A mean of 67 vessels/mm2 was noted. No lymphoid aggregates were seen. In all cases, infiltration of macrophages and lymphocytes was limited mainly to relatively superficial parts of synovium, i.e., within 1 to 2 high power fields of the surface.

Conclusion. An absence of lymphoid aggregates or dramatic vascularity and a predominantly superficial infiltrate consisting mainly of perivascular T cells with few B cells characterized our patients with very early RA of < 6 weeks' duration. Thus, there appear to be some potentially important differences from findings reported in well established disease. (J Rheumatol 2004;31:1281-5)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
VERY EARLY SYNOVITIS
QUANTITATIVE IMMUNOHISTOCHEMISTRY


From the Division of Rheumatology, University of Minnesota, Minneapolis, Minnesota; Beebe Hospital, Lewes, Delaware; and the University of Pennsylvania School of Medicine and Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA.

Supported by a postdoctoral fellowship grant 38091M, The Arthritis Foundation, Eastern Missouri Chapter.

J.A. Singh, MD, MPH, Assistant Professor of Medicine, Division of Rheumatology, Minneapolis VA Medical Center and University of Minnesota; J.A. Pando, MD, Private Rheumatologist, Beebe Hospital; J. Tomaszewski, MD, Professor of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine; H.R. Schumacher, MD, Professor of Medicine, Division of Rheumatology, University of Pennsylvania School of Medicine and Philadelphia VA Medical Center.

Address reprint requests to Dr. H.R. Schumacher, Philadelphia VA Medical Center, Arthritis Research 151-K, University and Woodland Avenues, Philadelphia, PA 19104. E-mail: schumacr@mail.med.upenn.edu

Submitted May 29, 2003; revision accepted January 14, 2004.




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