title: Patients with rheumatoid arthritis in clinical remission manifest persistent joint inflammation on histology and imaging studies.
abstract: OBJECTIVE
  The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology.
  
  
  METHODS
  We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined.
  
  
  RESULTS
  Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US.
  
  
  CONCLUSIONS
  Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester. allen_anandarajah@urmc.rochester.edu.
authors.forename: Allen
authors.initials: A
authors.lastname: Anandarajah
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
authors.forename: Ralf
authors.initials: R
authors.lastname: Thiele
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
authors.forename: Ellen
authors.initials: E
authors.lastname: Giampoli
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
authors.forename: Johnny
authors.initials: J
authors.lastname: Monu
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
authors.forename: Gwy-Suk
authors.initials: GS
authors.lastname: Seo
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
authors.forename: Changyong
authors.initials: C
authors.lastname: Feng
authors.affiliation: From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Ritchlin
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis* / Q000188:drug therapy; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: HISTOLOGY; MAGNETIC RESONANCE IMAGING; REMISSION; RHEUMATOID ARTHRITIS; ULTRASOUND