Synovial tissue protease gene expression and joint erosions in early rheumatoid arthritis

Objective. To relate the expression of proteases in the lining and sublinin g layers of the synovial membrane to the rate of joint damage during 1 year in patients with early inflammatory arthritis. Methods. Samples of synovial membrane were obtained by closed-needle biopsy or needle arthroscopy from inflamed knees of 20 patients with early inflam matory polyarthritis (mean disease duration 9.6 months, range 2 weeks to 18 months). Expression of matrix metalloproteinase 1 (MMP-1), cathepsin B (CB ), and cathepsin L (CL) was examined using in situ hybridization. Immunohis tochemistry was used to identify infiltrating mononuclear cell populations. Radiographs of the hands and feet, performed at presentation and after 1 y ear, were evaluated for the development of new erosions. Results. Twelve patients had rheumatoid arthritis (RA), 6 had psoriatic art hritis (PsA), 1 had gout, and 1 had an undifferentiated arthritis. Six pati ents had erosions at presentation. Eleven patients (10 with RA, 1 with PsA) demonstrated at least 1 new erosion after 1 year of followup. MMP-1, CB, a nd CL messenger RNA (mRNA) were expressed in the synovial membrane of all p atients and were present throughout the lining layer, as well as in perivas cular cellular infiltrates and endothelial cells in the sublining layer. In the lining layer, the mean percentages of protease mRNA-positive cells per high-power field were higher in those patients who developed new joint ero sions than in those without evidence of joint damage. A similar pattern was observed in the sublining layer, where mean numbers of protease mRNA-posit ive cells were also greater in patients with new joint erosions. There were significant differences between the two groups in MMP-1 mRNA expression in both the lining and sublining layers (P = 0.0007 and P = 0.0027, respectiv ely), as well as in sublining layer CL mRNA expression (P = 0.017), but not in CB mRNA expression. Numbers of lining layer CD68+ cells correlated posi tively with lining layer MMP-1 mRNA expression (P = 0.043) and with the dev elopment of new joint erosions (P = 0.002). Conclusion. The detection of MMP-1, CB, and CL in the synovium soon after t he onset of symptoms highlights the potential for early joint destruction i n patients with RA. High levels of MMP-1 mRNA expression in the lining laye r distinguished patients with more rapidly progressive erosive disease. Thi s is the first study to demonstrate features of early synovial pathophysiol ogy that may identify patients at increased risk of developing new joint er osions.