title: Power Doppler ultrasonographic assessment of the joint-draining lymph node complex in rheumatoid arthritis: a prospective, proof-of-concept study on treatment with tumor necrosis factor inhibitors.
abstract: Emerging research on the mechanisms of disease chronicity in experimental arthritis has included a new focus on the draining lymph node (LN). Here, we combined clinical-serological analyses and power Doppler ultrasound (PDUS) imaging to delineate noninvasively the reciprocal relationship in vivo between the joint and the draining LN in patients with rheumatoid arthritis (RA).
  
  
  
  Forty consecutive patients refractory to conventional synthetic disease-modifying anti-rheumatic drugs were examined through parallel PDUS of the hand-wrist joints and axillary LNs and compared with 20 healthy subjects. A semiquantitative score for LN gray-scale (GS) parameters (nodal hypertrophy and cortical structure) and LN PD signal was developed. A 6-month follow-up study with serial sonographic assessments was then performed on initiation of tumor necrosis factor (TNF) inhibitors.
  
  
  
  PDUS analysis of RA axillary LNs revealed the existence of marked inter-individual heterogeneity and of quantitative differences compared with healthy individuals in both GS and PD characteristics. RA LN changes were plastic, responsive to anti-TNF treatment, and displayed a degree of concordance with synovitis activity in peripheral joints. However, low LN PD signal at baseline despite active arthritis was strongly associated with a poor clinical response to TNF blockade.
  
  
  
  PDUS analysis of the draining LN in RA allows capture of measurable inter-individual differences and dynamic changes linked to the underlying pathologic process. LN and joint sonographic assessments are nonredundant approaches that may provide independent perspectives on peripheral disease and its evolution over time.
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy. antonio.manzo@unipv.it.
authors: Antonio
authors: 0000-0002-9743-6008
authors: A
authors: Manzo
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
authors: Francesca
authors: F
authors: Benaglio
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
authors: Barbara
authors: B
authors: Vitolo
authors: Division of Radiology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy.
authors: Chandra
authors: C
authors: Bortolotto
authors: Division of Radiology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy.
authors: Francesca
authors: F
authors: Zibera
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
authors: Monica
authors: M
authors: Todoerti
authors: Laboratory of Biochemical-Clinical Analyses, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors: Claudia
authors: C
authors: Alpini
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
authors: Serena
authors: S
authors: Bugatti
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
authors: Roberto
authors: R
authors: Caporali
authors: Division of Radiology, IRCCS Policlinico San Matteo Foundation/University of Pavia, Pavia, Italy.
authors: Fabrizio
authors: F
authors: Calliada
authors: Rheumatology and Translational Immunology Research Laboratories (LaRIT) and Biologic Therapy Unit, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia, P.le Golgi 19, 27100, Pavia, Italy.
authors: Carlomaurizio
authors: C
authors: Montecucco
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D018608:Ultrasonography, Doppler
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Lymph node; Rheumatoid arthritis; Ultrasonography