title: Synovium CD20 expression is a potential new predictor of bone erosion progression in very-early arthritis treated by sequential DMARDs monotherapy -- a pilot study from the VErA cohort.
abstract: OBJECTIVE
  Because available biomarkers (rheumatoid factors [RF], anti-cyclic citrullinated autoantibodies [anti-CCP2], erythrocyte sedimentation rate at 1st hour [ESR]/C-reactive peptide [CRP] and bone erosions) are insufficient to predict rheumatoid arthritis (RA) structural damage, to determine whether synovium expression of greater or equal to 1 markers could constitute new prognostic factor(s).
  
  
  METHODS
  The study was conducted on 18 prospectively enrolled disease-modifying anti-rheumatic drug (DMARD)- and glucocorticoid-naïve, VErA cohort patients with very-early arthritis (median duration: 4months). Recorded at baseline were: clinical and biological (serum ESR, CRP, RF-isotypes, anti-CCP2, osteoprotegerin, receptor activator of nuclear κB-ligand [RANK-L] and cartilage oligomeric matrix protein [COMP] levels) data; synovium expression (HLA-DR, CD163, CD3, CD20, VEGF, osteoprotegerin, RANK-L, Bcl2 and global inflammation index) for a metacarpophalangeal joint-synovium biopsy. Baseline and 3-year hand-and-foot X-rays were graded with the van der Heijde-modified-Sharp score; the judgment criterion was its progression during follow-up. Pearson's product moment correlation statistics were used to test for association between paired samples.
  
  
  RESULTS
  A baseline, a significant relationship was found between erosive damage and markers of B-cell activation, notably the synovium CD20 expression (r=0.68; P=0.0001). Quantified by the modified-Sharp erosion score variation, the 3-year structural damage progression was significantly correlated with: serum levels of RF-IgG (r=0.75; P=0.0003), -IgM (r=0.69; P=0.001), anti-CCP2 (r=0.53; P=0.02) and RANK-L (r=0.61; P=0.007); synovium CD20 expression (r=0.70; P=0.001).
  
  
  CONCLUSIONS
  This analysis of the prognostic value of a large panel of synovium markers in a limited sample of prospectively followed, well-documented patients suggested that both synovial CD20 and serum RANK-L levels might be new predictors of structural damage progression in very-early RA.
authors.affiliation: INSERM U905, Department of Rheumatology, University of Rouen, Institute for Biomedical Research, Rouen University Hospital, Rouen, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Lanfant-Weybel
authors.forename: Chantal
authors.initials: C
authors.lastname: Michot
authors.forename: Romain
authors.initials: R
authors.lastname: Daveau
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Milliez
authors.forename: Isabelle
authors.initials: I
authors.lastname: Auquit-Auckbur
authors.forename: Patrice
authors.initials: P
authors.lastname: Fardellone
authors.forename: Michel
authors.initials: M
authors.lastname: Brazier
authors.forename: Othmane
authors.initials: O
authors.lastname: Mejjad
authors.forename: Alain
authors.initials: A
authors.lastname: Daragon
authors.forename: Kataryna
authors.initials: K
authors.lastname: Krzanowska
authors.forename: Fabienne
authors.initials: F
authors.lastname: Jouen
authors.forename: François
authors.initials: F
authors.lastname: Tron
authors.forename: François
authors.initials: F
authors.lastname: Le Loarer
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
mesh_terms: D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000378:metabolism*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D001862:Bone Resorption / Q000175:diagnosis / Q000378:metabolism*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008662:Metacarpophalangeal Joint / Q000473:pathology; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D053245:RANK Ligand / Q000097:blood; D013583:Synovial Membrane / Q000276:immunology* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018951:Antigens, CD20; D018501:Antirheumatic Agents; D015415:Biomarkers; D053245:RANK Ligand; C505688:TNFSF11 protein, human