SYNOVIAL-MEMBRANE CYTOKINE PROFILES IN REACTIVE ARTHRITIS SECONDARY TO INTRAVESICAL BACILLUS-CALMETTE-GUERIN THERAPY

We describe the cellular infiltrate and cytokine profile in sequential synovial membrane biopsies from a patient with acute followed by chro nic synovitis after intravesical bacillus Calmette-Guerin (BCG) therap y for an in situ transitional cell carcinoma of the bladder. Histologi cal and immune; histochemical analyses of 3 synovial biopsies were don e sequentially over a 9 month period. The patient was HLA-B27 positive , but HLA-DR4 negative, and did not have the ''shared epitope,'' Unlik e other cases, this patient's arthritis did not respond initially to n onsteroidal antiinflammatory drugs and was exacerbated by corticostero id therapy, The synovitis took a neutrophilic form; with marked synovi al membrane content of interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-alpha). It subsequently developed into chronic lymphoplasma cytoid synovitis, similar to rheumatoid arthritis (RA), with decreased IL-8 but continuing IL-1 and TNF-alpha production in the synovial mem brane, The synovitis resolved to a fibrotic synovium with residual thi ckening of the synovial lining layer and continued production of TNF-a lpha. Thus, during the evolution of this arthritis, the synovial membr ane yielded a cellular infiltrate and cytokine content that had marked similarities with that seen in RA; however, the arthritis eventually remitted spontaneously.