Li JianBin, Liu PengCheng, Huang YiPing, Wang Yan, Zhao Jun, Xiong ZhenFang, Liu MengXia, Wu Rui
Department of Rheumatology and Immunology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
Department of Pathology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
Heliyon. 2024 Jul 4;10(13):e34088. doi: 10.1016/j.heliyon.2024.e34088. eCollection 2024 Jul 15.
To examine the clinical features and synovial pathologies in rheumatoid arthritis (RA) patients across varying titers of circulating anti-citrullinated protein antibodies (ACPA).
We devised a negative pressure suction and rebound synovial biopsy tool to enhance the yield of synovial biopsies, noted for its ease and safety of use. This research involved a retrospective examination of 60 active RA patients who underwent synovial biopsies with this tool from June to November 2013 at our institution. A range of disease activity markers were collected, including DAS28-CRP, ESR, CRP, count of swollen and tender joints, VAS pain scale, and so forth. Synovial tissue underwent HE staining and immunohistochemistry, including synovitis grading (GSS) and counting of B cells (CD20), T cells (CD3), macrophages (CD68), and plasma cells (CD138).
were categorized into three groups as per ACPA titers: ACPA-negative (0-5U/mL), low-titer (5-20U/mL), and high-titer (above 20U/mL). The study compared the clinical features and synovial pathologies across these groups.
Of the 60 RA patients, they were segregated into three groups based on ACPA titers: 20 in ACPA-negative, 9 in the low-titer group, and 31 in the high-titer group. No significant differences were observed in GSS scores, synovial cell proliferation and loss, matrix activation, inflammatory infiltration, and neovascularization among these groups (P > 0.05). The high-titer ACPA group demonstrated significantly increased counts of CD3 T cells, CD20 B cells, and CD68 macrophages in synovial tissues compared to the ACPA-negative and low-titer groups (p < 0.05), along with a higher incidence of ectopic lymphoid neogenesis (p < 0.05). Ordinal logistic regression revealed that rheumatoid factor (RF), and counts of synovial T cells, B cells, macrophages, and ectopic lymphoid neogenesis correlated with ACPA titers (P < 0.05), particularly lymphoid neogenesis (OR = 3.63, P = 0.023).
RA patients with high-titer ACPA demonstrate elevated levels of inflammatory cell infiltration in synovial tissues, with ectopic lymphoid neogenesis showing a strong correlation with high ACPA positivity.
研究不同循环抗瓜氨酸化蛋白抗体（ACPA）滴度的类风湿关节炎（RA）患者的临床特征和滑膜病理变化。
我们设计了一种负压吸引和反弹式滑膜活检工具，以提高滑膜活检的成功率，该工具使用简便且安全。本研究回顾性分析了2013年6月至11月在我院使用该工具进行滑膜活检的60例活动性RA患者。收集了一系列疾病活动指标，包括DAS28-CRP、血沉（ESR）、C反应蛋白（CRP）、肿胀和压痛关节计数、视觉模拟评分（VAS）疼痛量表等。滑膜组织进行苏木精-伊红（HE）染色和免疫组织化学检查，包括滑膜炎分级（GSS）以及B细胞（CD20）、T细胞（CD3）、巨噬细胞（CD68）和浆细胞（CD138）计数。
根据ACPA滴度分为三组：ACPA阴性（0-5U/mL）、低滴度（5-20U/mL）和高滴度（>20U/mL）。本研究比较了三组患者的临床特征和滑膜病理变化。
60例RA患者根据ACPA滴度分为三组：ACPA阴性组20例，低滴度组9例，高滴度组31例。三组间GSS评分、滑膜细胞增殖与丢失、基质激活、炎症浸润和新生血管形成方面差异无统计学意义（P>0.05）。与ACPA阴性组和低滴度组相比，高滴度ACPA组滑膜组织中CD3 T细胞、CD20 B细胞和CD68巨噬细胞计数显著增加（p<0.05），异位淋巴组织新生发生率更高（p<0.05）。有序逻辑回归显示，类风湿因子（RF）、滑膜T细胞、B细胞、巨噬细胞计数和异位淋巴组织新生与ACPA滴度相关（P<0.05），尤其是淋巴组织新生（比值比[OR]=3.63，P=0.023）。
高滴度ACPA的RA患者滑膜组织中炎症细胞浸润水平升高，异位淋巴组织新生与高ACPA阳性密切相关。
