Rheumatoid Arthritis Basic Science Studies
Differences in synovial tissue infiltrates between anti–cyclic citrullinated peptide–positive rheumatoid arthritis and anti–cyclic citrullinated peptide–negative rheumatoid arthritis
Article first published online: 28 DEC 2007
Copyright © 2008 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 58, Issue 1, pages 53–60, January 2008
How to Cite
van Oosterhout, M., Bajema, I., Levarht, E. W. N., Toes, R. E. M., Huizinga, T. W. J. and van Laar, J. M. (2008), Differences in synovial tissue infiltrates between anti–cyclic citrullinated peptide–positive rheumatoid arthritis and anti–cyclic citrullinated peptide–negative rheumatoid arthritis. Arthritis & Rheumatism, 58: 53–60. doi: 10.1002/art.23148
- Issue published online: 28 DEC 2007
- Article first published online: 28 DEC 2007
- Manuscript Accepted: 28 SEP 2007
- Manuscript Received: 22 FEB 2007
To compare synovial tissue infiltrates from patients with anti–cyclic citrullinated peptide (anti-CCP)–positive rheumatoid arthritis (RA) with those from patients with anti-CCP–negative RA.
Synovial tissue samples were obtained arthroscopically from the inflamed knee joints of 57 patients with RA (34 of whom were anti-CCP positive) and examined for several histologic features along with immunohistologic expression of cell markers. Joint damage was assessed using the Kellgren/Lawrence (K/L) scale (range 0–4) on standard anteroposterior radiographs. In 31 patients (18 of whom were anti-CCP positive), synovial tissue was available from an earlier time point, allowing analysis of temporal changes.
Synovial tissue from anti-CCP–positive patients was characterized by a higher mean number of infiltrating lymphocytes (61.6 versus 31.4/high-power field [hpf] [400×]; P = 0.01), less extensive fibrosis (mean score of 1.2 versus 2.0; P = 0.04), and a thinner synovial lining layer (mean score of 2.1 versus 3.3; P = 0.002) compared with synovial tissue from anti-CCP–negative patients. Anti-CCP–positive patients expressed more CD3, CD8, CD45RO, and CXCL12. More anti-CCP–positive patients had a K/L score >1 compared with anti-CCP–negative patients. The difference in the mean lymphocyte counts was already present a mean of 3.8 years before the index biopsy (76.7 lymphocytes/hpf and 26.7 lymphocytes/hpf in anti-CCP–positive patients and anti-CCP–negative patients, respectively; P = 0.008) and was independent of disease duration and K/L score.
Synovitis in patients with anti-CCP–positive RA differs from that in patients with anti-CCP– negative RA, notably with respect to infiltrating lymphocytes, and is associated with a higher rate of local joint destruction.