Synovial tissue macrophages: a sensitive biomarker for response to treatment in patients with rheumatoid arthritis.
BACKGROUND
Previous work identified synovial sublining macrophage numbers as a potential biomarker for clinical efficacy in rheumatoid arthritis.


OBJECTIVE
To investigate the association between changes in infiltration of synovial macrophages and clinical improvement after antirheumatic treatment.


METHODS
88 patients who participated in various clinical trials were studied. All patients underwent serial arthroscopy before initiation of treatment and after different time intervals. Immunohistochemical and digital image analysis were performed according to standardised procedures to detect changes in CD68+ synovial sublining macrophages in relationship to changes in the 28 joint count Disease Activity Score (DAS28). Statistical analysis was performed using one way analysis of variance, the independent samples t test, linear regression, and the standardised response mean (SRM).


RESULTS
For good, moderate, and non-responders, according to the DAS28 response criteria, there was a significant difference in the change in sublining macrophages (mean (SEM) cells/mm(2) -643 (124), -270 (64), and -95 (60), respectively; p<0.0003). There was a significant correlation between the change in the number of macrophages and the change in DAS28 (Pearson correlation 0.874, p<0.01). The change in sublining macrophages explained 76% of the variation in the change in DAS28 (p<0.02). The sensitivity to change of the biomarker was high in patients treated actively (SRM >0.8), whereas the ability to detect changes in placebo treated patients was weak (SRM <0.3).


CONCLUSIONS
The results suggest that changes in synovial sublining macrophages can be used to predict possible efficacy of antirheumatic treatment.
Haringman
J J
JJ
Division of Clinical Immunology and Rheumatology, F4-218, Academic Medical Centre/University of Amsterdam, Meibergdreef 9, NL-1105 AZ Amsterdam, The Netherlands.
Gerlag
D M
DM
Zwinderman
A H
AH
Smeets
T J M
TJ
Kraan
M C
MC
Baeten
D
D
McInnes
I B
IB
Bresnihan
B
B
Tak
P P
PP
D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology*; D001182:Arthroscopy; D015415:Biomarkers / Q000032:analysis; D002452:Cell Count; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008264:Macrophages / Q000473:pathology*; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000473:pathology*; D016896:Treatment Outcome; D000097382:CD68 Molecule
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D018501:Antirheumatic Agents; D015415:Biomarkers; C067980:CD68 antigen, human; D000097382:CD68 Molecule