title: Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?
abstract: OBJECTIVE
  To define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockers.
  
  
  METHODS
  Patients with RA in remission (n=25) (disease activity score (DAS)<1.6 for at least 6 months), patients with RA in low disease activity (LDA) (n=10) (1.6<DAS<2.4 for at least 6 months) and patients with PsA in remission (n=18) (DAS<1.6 and Psoriasis Area Severity Index (PASI)=0 for at least 6 months) achieved by MTX+anti-TNF (adalimumab 40 mg or etanercept 50 mg) with power Doppler (PDUS)-negative synovial hypertrophy underwent synovial tissue biopsy. Patients with RA with high/moderate disease naïve to treatment (n=50) were included as a comparison group. Immunostaining for cluster designation (CD)68, CD21, CD20, CD3, CD31 and collagen was performed.
  
  
  RESULTS
  PDUS-negative patients with RA in remission showed lower histological scores for synovial CD68+, CD20+, CD3+cells and CD31+vessels and collagen deposition (p<0.05 for both lining and sublining) compared with PDUS-positive patients with RA with high/moderate disease. In addition, there was no significant difference in terms of lining and sublining CD68+, CD20+, CD3+, CD31+cells and collagen comparing PDUS-negative patients with RA in remission and in LDA, respectively. On the contrary, PDUS-negative patients with PsA in remission showed higher histological scores for sublining CD68+(p=0.02) and CD3+cells (p=0.04) as well as CD31+vessels (p<0.001) than PDUS-negative patients with RA in remission.
  
  
  CONCLUSIONS
  PDUS-negative patients with RA in remission have comparable synovial histological features than PDUS-negative patients with RA in LDA. However, patients with PsA in remission are characterised by a higher degree of residual synovial inflammation than patients with RA in remission, despite PDUS negativity under TNF inhibition.
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Alivernini
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tolusso
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Petricca
authors.affiliation: Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bui
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Sante
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giusy
authors.initials: G
authors.lastname: Peluso
authors.affiliation: Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Benvenuto
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Anna Laura
authors.initials: AL
authors.lastname: Fedele
authors.affiliation: Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Federico
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
authors.affiliation: Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D018951:Antigens, CD20 / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D017252:CD3 Complex / Q000378:metabolism; D003094:Collagen / Q000378:metabolism; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D017464:Receptors, Complement 3d / Q000378:metabolism; D012008:Recurrence; D012074:Remission Induction; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D013585:Synovitis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014463:Ultrasonography; D018608:Ultrasonography, Doppler; D000097382:CD68 Molecule
chemical_list: D000068879:Adalimumab; D015703:Antigens, CD; D018951:Antigens, CD20; D015214:Antigens, Differentiation, Myelomonocytic; D018501:Antirheumatic Agents; D017252:CD3 Complex; D003094:Collagen; D000068800:Etanercept; D008727:Methotrexate; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D017464:Receptors, Complement 3d; D014409:Tumor Necrosis Factor-alpha; C067980:CD68 antigen, human; D000097382:CD68 Molecule
keywords: Anti-TNF; Psoriatic Arthritis; Rheumatoid Arthritis; Synovitis; Ultrasonography