Histology of the synovial tissue: Value of semiquantitative analysis for the prediction of joint erosions in rheumatoid arthritis

Objective Routine histologic techniques are still the main procedure in the study of the synovial biopsy. The relationship between the typical histological chan ges of rheumatoid synovium and clinical manifestations has not been studied in detail. Methods With the aim of determining whether a simple semiquantitative method of eva luating the changes in closed synovial biopsies was of clinical value ill a ssessing both the diagnosis and prognosis of rheumatoid arthritis (RA) pati ents, we evaluated retrospectively 72 synovial biopsy specimens (26 RA pati ents, 30 patients with other inflammatory diseases and 16 osteoarthritis pa tients). Scores (0-10) were assigned to each biopsy specimen for each of 6 histologic features: synoviocyte hyperplasia; fibrosis in the subsynovial l ayer; proliferating blood vessels; perivascular infiltrates of lymphocytes; focal aggregates of lymphocytes; and diffuse infiltrates of lymphocytes. S cores were compared between the 3 groups and also between the RA subgroups with early and late disease; positive and negative rheumatoid factor; with and without joint erosions; and with and without systemic disease. Results Significant differences irt the mean global score (mean of the 6 scores) we re found both between RA and osteoarthritis and between other inflammatory diseases and osteoarthritis (p < 0.01). The mean global score for RA was hi gher than the mean global score obtained for the other inflammatory disease s, but the difference was not significant We found a significantly higher m ean global score in the RA patients with erosions in comparison to the XA p atients without erosions, this difference being particularly evident for th e lymphocyte perivascular infiltrate (p < 0.05). There were no significant differences between the other RA subgroups. Conclusion In this stimy MIC have identified differences, using routine histologic tec hniques, between the rheumatoid synovial membrane of patients with and with out erosions. Based on our present observations we suggest that the intensi ty of inflammatory histological features and, in particular a high percenta ge of vessels with perivascular lymphocyte infiltrate might be of prognosti c value in RA.