Background/Purpose:

Multiple studies addressing the effects of biologics on the synovial tissue in rheumatoid arthritis (RA) patients have been reported. There are, however, few studies comparing histopathological changes in the synovial tissue in the same RA patients between before and after biologics treatment.We examined the inflammation of synovium before and after biologic agents in the patients with rheumatoid arthritis (RA) and to investigate the association between synovial histopathology and disease activity.

Methods:

Synovial tissues were collected from 34 RA joints before and after biologics. The average age and disease duration of the study subjects were 64.0 and 22.5 respectively. Histopathological changes in the synovial tissues were compared based on Rooney’s score, and presence or absence of fibrinoid degeneration, proliferation of villi and plasma cell infiltration in the subsynovial tissue. We examined correlation between pathological findings in RA synovium and disease activity under biologics. Disease activity was assessed by CDAI. Etanercept, Infliximab, Tocilizumab, Adalimumab and Abatacept was used as biological drug for 18, 6 ,5 ,3 and 2 joints respectively.

Results:

Rooney score between before and after biological drug usage improved from 28.4 to 12.0 showing significant difference. Significant improvement in Rooney score was observed in all items. Fibrinoid degeneration was observed in 29 cases (85.3%) and 6 cases (17.6%) before and after biologics treatment, respectively, demonstrating a significant reduction with biologics treatment. Proliferation of villi was observed in 32 cases (94.1%) and 11 (32.4%) before and after biologics treatment, respectively, demonstrating a significant reduction with biologics treatment. After the use of biologic agents, Moderate disease activity group had significantly higher in scores of focal aggregates of lymphocytes (P=0.02), diffuse infiltrates of lymphocytes (P=0.019), and Rooney total scores (P=0.002) than Remission and Low disease activity groups.

Conclusion:

The study results demonstrated that biologics treatment significantly decreased inflammatory changes in the synovial lining layers and sublining layers. In addition, the results suggested that histopathological findings in the subsynovial tissue reflected disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-biologic-agents-on-synovial-tissues-from-patients-with-rheumatoid-arthritis/