Association of clinical, radiological and synovial immunopathological responses to anti-rheumatic treatment in rheumatoid arthritis

Objectives. To compare immunohistochemical scoring with clinical scoring an d radiology for the assessment of rheumatoid arthritis (RA) disease activit y, synovial tissue (ST) biopsied arthroscopically was assessed from 18 pati ents before and after commencement of disease-modifying anti-rheumatic drug (DMARD) therapy. Methods. Lymphocytes, macrophages, differentiated dendritic cells (DC), vas cularity, tumour necrosis factor (TNF)alpha and interleukin-1 beta levels w ere scored. Clinical status was scored using the American College of Rheuma tology (ACR) core set and serial radiographs were scored using the Larsen a nd Sharp methods. Histopathological evidence of activity included infiltrat ion by lymphocytes, DC, macrophages. tissue vascularity, and expression of lining and sublining TNF alpha. These indices co-varied across the set of S T biopsies and were combined as a synovial activity score for each biopsy. Results. The change in synovial activity with treatment correlated with the ACR clinical response and with decreased radiological progression by the L arsen score, The ACR response to DMARD therapy. the change in synovial acti vity score and the slowing of radiological progression were each greatest i n patients with high initial synovial vascularity. Conclusions. The data demonstrate an association between clinical, radiolog ical and synovial immunopathological responses to anti-rheumatic treatment in RA. High ST vascularity may predict favourable clinical and radiological responses to treatment.