Synovial effusion and synovial fluid biomarkers in psoriatic arthritis to assess intraarticular tumor necrosis factor-alpha blockade in the knee joint

Fiocco, Ugo; Sfriso, Paolo; Oliviero, Francesca; Roux-Lombard, Pascale; Scagliori, Elena; Cozzi, Luisella; Lunardi, Francesca; Calabrese, Fiorella; Vezzu, Maristella; Dainese, Serena; Molena, Beatrice; Scanu, Anna; Nardacchione, Roberto; Rubaltelli, Leopoldo; Dayer, Jean-Michel; Punzi, Leonardo

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Title		Synovial effusion and synovial fluid biomarkers in psoriatic arthritis to assess intraarticular tumor necrosis factor-alpha blockade in the knee joint
Authors		Fiocco, Ugo Sfriso, Paolo Oliviero, Francesca Roux-Lombard, Pascale Scagliori, Elena Cozzi, Luisella Lunardi, Francesca Calabrese, Fiorella Vezzu, Maristella Dainese, Serena Molena, Beatrice Scanu, Anna Nardacchione, Roberto Rubaltelli, Leopoldo Dayer, Jean-Michel Punzi, Leonardo show all authors [1 - 16]
Published in		Arthritis Research and Therapy. 2010, vol. 12, no. 4, p. R148
Abstract		INTRODUCTION: The purpose of this study was the evaluation of synovial effusion (SE), synovial fluid (SF) and synovial tissue (ST) biomarkers in relation to disease activity indexes to assess the response to intraarticular (IA) tumor necrosis factor (TNF)-alpha blockers in psoriatic arthritis (PsA). METHODS: Systemic and local disease activity indexes (disease activity score (DAS); the Ritchie articular index (mRAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); Thompson articular (THOMP) and joint articular (KJAI)-Index ) and ST samples were assessed at baseline, throughout treatment, and during the follow-up in 14 patients affected with PsA who underwent IA injections (0.5 ml to 12.5 mg) in the knee joint of etanercept (E) or placebo (P) once every two weeks for a 10-week period. Total SF white blood cell (WBC) counts (WBC/mul) and SF cytokine/chemokine (CK/CCK) levels were measured before IA-E at baseline, after IA-E, and as long as there were adequate amounts of SF for knee aspiration (post). Characterization of synovial mononuclear cell infiltration and synovial vessels was carried out in 8 out of 14 knees by staining serial sections of synovial tissue biopsies for CD45, CD3, CD68, CD31 and CD105. RESULTS: At baseline, CRP and/or ESR were significantly correlated with SF-CK (interleukin- (IL-)1beta, IL-1Ra, IL-6, IL-8) and CCK (CCL3). Post-IA injections, there was a decrease in SE in the knees in which aspiration following IA-E injection was possible as well as a significant reduction in SF WBC/mul and in SF-CK (IL-1beta, IL-1Ra, IL-6 and IL-22). Pre- and post-IA-E injections, there were significant correlations between ST markers and SF-CK (IL-1beta with CD45; IL-1beta and IL-6 with CD31) and between SF-CCK (CCL4 and CCL3 with CD3). At the end of the study, there was a significant reduction in disease activity indexes (CRP, DAS, RAI, THOMP, KJAI) as well as in the ST markers (CD45; CD3). CONCLUSIONS: Synovial effusion regression is a reliable indicator of the response to IA TNF-alpha blockers in PsA patients as it is confirmed by the correlation between SF biomarkers to disease activity and synovial tissue inflammation.
Keywords		Arthritis, Psoriatic/drug therapy/metabolism/pathology — Biological Markers/metabolism — Drug Monitoring/methods/standards — Humans — Immunosuppressive Agents/administration & dosage — Injections, Intra-Articular — Interleukin 1 Receptor Antagonist Protein/metabolism — Interleukin-1beta/metabolism — Interleukin-6/metabolism — Interleukins/metabolism — Knee Joint/metabolism/pathology — Leukocyte Count — Reproducibility of Results — Synovial Fluid/metabolism — Synovial Membrane/metabolism/pathology — Tumor Necrosis Factor-alpha/antagonists & inhibitors
Identifiers		DOI: 10.1186/ar3090 PMID: 20642840
Full text		Article (Author postprint) - Free access Other version: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945042/pdf/ar3090.pdf
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine interne des spécialités
Research group		Etude de l'activation des monocytes/macrophages et des polynucléaires neutrophiles (779)
Citation (ISO format)		FIOCCO, Ugo et al. Synovial effusion and synovial fluid biomarkers in psoriatic arthritis to assess intraarticular tumor necrosis factor-alpha blockade in the knee joint. In: Arthritis Research and Therapy, 2010, vol. 12, n° 4, p. R148. https://archive-ouverte.unige.ch/unige:20623