Krenn V, Waldstein W, Najm A, Perino G, Gaulke R
MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik GmbH, Max-Planck-Str. 5, Trier, Deutschland.
AKH-Wien, Universitätsklinik für Orthopädie, Medizinische Universität Wien, Wien, Österreich.
Orthopade. 2018 Nov;47(11):941-948. doi: 10.1007/s00132-018-3649-x.
Even though the diagnostics of rheumatic joint diseases are mostly based on clinical, immunoserological and imaging criteria, histopathology can also make a significant contribution. This is particularly true for clinically unclear monoarticular and periarticular diseases. The contribution of histopathology to the diagnosis of rheumatic diseases is manifold since the histopathological differential diagnosis includes the complete spectrum of synovial diseases. This heterogeneous pathogenetic spectrum is described in the joint pathology algorithm, which includes inflammatory and non-inflammatory diseases. To the latter group belong certain benign tumors such as the diffuse variant of the tenosynovial giant cell tumor, lipoma, hemangioma, vascular malformations and synovial chondromatosis. Additionally, the rare group of storage diseases should be kept in mind. Inflammatory diseases can be discriminated into crystal-induced arthropathies mainly such as gout and pseudogout, into granulomatous diseases such as tuberculosis and foreign-body inoculations, and finally into the large group of non-granulomatous, non-infectious synovitis. This large group is by far the most common, and it often causes difficulties in assigning the histopathological findings to a concrete rheumatologic diagnosis. In this context the synovitis score should be applied as a diagnostic device in these cases, leading to the diagnosis of a low-grade synovitis (which is associated with degenerative arthropathies) or of a high-grade synovitis (associated with rheumatic diseases). Identification of crystals and crystal-like deposits should be carried out with the application of the joint particle algorithm which addresses the identification of endogenous and non-endogenous particle deposits in the synovial tissues. Additionally, the synovitis-score may be used for evaluation of arthritis-progresssion and for the evaluation of inflammation-regression as a consequence of therapy with biologicals.
尽管风湿性关节疾病的诊断大多基于临床、免疫血清学和影像学标准，但组织病理学也能做出重要贡献。这在临床情况不明的单关节和关节周围疾病中尤为如此。组织病理学对风湿性疾病诊断的贡献是多方面的，因为组织病理学鉴别诊断涵盖了滑膜疾病的全谱。这种异质性的致病谱在关节病理学算法中有所描述，该算法包括炎症性和非炎症性疾病。后一组包括某些良性肿瘤，如腱鞘巨细胞瘤的弥漫性变体、脂肪瘤、血管瘤、血管畸形和滑膜软骨瘤病。此外，还应牢记罕见的贮积病组。炎症性疾病可分为主要如痛风和假性痛风的晶体诱导性关节病、如结核病和异物接种的肉芽肿性疾病，以及最后一大组非肉芽肿性、非感染性滑膜炎。这一大组是迄今为止最常见的，并且在将组织病理学发现归为具体的风湿性诊断时常常造成困难。在这种情况下，滑膜炎症评分应作为这些病例的诊断工具，从而诊断出低度滑膜炎（与退行性关节病相关）或高度滑膜炎（与风湿性疾病相关）。晶体和晶体样沉积物的鉴定应采用关节颗粒算法进行，该算法用于鉴定滑膜组织中的内源性和非内源性颗粒沉积物。此外，滑膜炎症评分可用于评估关节炎的进展以及评估生物制剂治疗后炎症的消退情况。
