Effect of intra-articular infliximab on synovial membrane pathology in a patient with a seronegative spondyloarthropathy.
OBJECTIVE
To demonstrate the efficacy of intra-articular infliximab in a patient with a persistent monarthritis who had previously had two arthroscopic synovectomies with limited success, and to determine the effect of intra-articular infliximab on synovial membrane pathology


METHODS
Arthroscopic synovial biopsy specimens were collected before and after treatment with intra-articular infliximab. The synovial tissue was stained for a range of inflammatory cell subsets, cell adhesion molecules and cytokines using immunohistochemical techniques and quantified using digital image analysis and a semiquantitative scoring method.


RESULTS
Clinical improvement in the knee synovitis was seen after the first two intra-articular infliximab treatments, with a sustained clinical remission lasting for more than 12 months after the third treatment. Significant changes in cellular infiltration and expression of cytokines and cell adhesion molecules occurred as a result of treatment with intra-articular infliximab, with a reduction in some but not all cells in the inflammatory infiltrate, as well as a reduction in the expression of cell adhesion molecules (intercellular adhesion molecule-1 and vascular adhesion molecule-1) and production of cytokines (interleukin 1beta and tumour necrosis factor alpha).


CONCLUSIONS
Intra-articular infliximab administration is a viable treatment for a persistent monarthritis resistant to other treatment options and can successfully modulate the inflammatory milieu within the synovial membrane.
Ahern
M J
MJ
Rheumatology Research Unit, Repatriation General Hospital, South Australia.
Campbell
D G
DG
Weedon
H
H
Papangelis
V
V
Smith
M D
MD
D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D006801:Humans; D000069285:Infliximab; D007270:Injections, Intra-Articular; D025242:Spondylarthropathies / Q000188:drug therapy* / Q000473:pathology; D013583:Synovial Membrane; D013585:Synovitis / Q000188:drug therapy* / Q000473:pathology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab