title: Inflammation and vascularisation markers of arthroscopically-guided finger joint synovial biospies reflect global disease activity in rheumatoid arthritis.
abstract: OBJECTIVE
  To analyse whether synovial markers of the clinically dominant metacarpophalangeal (MCP) joint reflect global disease activity measures in rheumatoid arthritis (RA).
  
  
  METHODS
  Arthroscopically-guided synovial biopsies from the dominant metacarpophalangeal (MCP) joint of 10 patients with RA (DAS28 >3.2) were stained for determination of the synovitis score, CD68, vascular endothelial growth factor (VEGF), hypoxia-inducible factor 1α (HIF-1α). MRI and ultrasound were used to calculate the RAMRIS and US7 score respectively. Arthroscopy of the same joint was repeated in 6 patients after 6 months.
  
  
  RESULTS
  The synovitis score significantly correlated to DAS28 (Spearman r=0.74), CRP (r=0.69), and US7 (r=0.66); sublining CD68 macrophages to CRP (r=0.6); HIF-1α to DAS28 (r=0.77), CRP (r=0.73); and VEGF to DAS28 (r=0.753) and RAMRIS (r=0.663). All patients showed a reduction of the DAS28 after 6 months (mean±SD: 5.2±1.5 vs. 2.75±1.1; p<0.05). There were three patients with a good EULAR response, and only these showed declining sublining CD68 macrophages in the control biopsy (χ2 test: LR 8.3, p=0.05). Two of the remaining patients with increasing CD68 sublining macrophages showed a deterioration of the RAMRIS.
  
  
  CONCLUSIONS
  Some histological findings in arthroscopically-guided biopsies of the dominantly affected MCP joint reflect global disease activity measures and their changes in RA patients. Moreover, repeated MCP synovial biopsy may distinguish true responders from individuals with residual disease activity, who are not readily recognized by clinical means.
authors.affiliation: Heinrich-Heine-University, Department of Rheumatology, Düsseldorf, Germany. stefan.vordenbaeumen@med.uni-duesseldorf.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Vordenbäumen
authors.forename: Philipp
authors.initials: P
authors.lastname: Sewerin
authors.forename: Tim
authors.initials: T
authors.lastname: Lögters
authors.forename: Falk
authors.initials: F
authors.lastname: Miese
authors.forename: Christoph
authors.initials: C
authors.lastname: Schleich
authors.forename: Ellen
authors.initials: E
authors.lastname: Bleck
authors.forename: Paulina
authors.initials: P
authors.lastname: Philippski
authors.forename: Michael
authors.initials: M
authors.lastname: Schädel-Höpfner
authors.forename: Thomas
authors.initials: T
authors.lastname: Pauly
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ostendorf
mesh_terms: D042501:Angiogenic Proteins / Q000032:analysis*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D001182:Arthroscopy; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D016009:Chi-Square Distribution; D006801:Humans; D007150:Immunohistochemistry; D018836:Inflammation Mediators / Q000032:analysis*; D008264:Macrophages / Q000276:immunology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000187:drug effects / Q000276:immunology* / Q000473:pathology*; D009389:Neovascularization, Pathologic; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000276:immunology / Q000473:pathology; D013585:Synovitis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D042501:Angiogenic Proteins; D018501:Antirheumatic Agents; D015415:Biomarkers; D018836:Inflammation Mediators