RESEARCH - Diagnostic classification of SpA and RA by synovial histopathology

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Arthritis Rheum. 2004 Sep;50(9):2931-41.

Diagnostic classification of spondylarthropathy and rheumatoid arthritis

by synovial histopathology: a prospective study in 154 consecutive

patients.

Baeten D, Kruithof E, De Rycke L, Vandooren B, Wyns B, Boullart L,

Hoffman IE, Boots AM, Veys EM, De Keyser F.

Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.

dominique.baete@...

OBJECTIVE: To explore prospectively the value of synovial histopathology

in comparison with the value of classic parameters for diagnostic

classification of spondylarthropathy (SpA) and rheumatoid arthritis (RA)

in patients with an atypical disease presentation. METHODS: Synovial

biopsy samples were obtained from 154 consecutive patients presenting

for diagnostic evaluation; 67 patients fulfilled the classification

criteria for RA, SpA, or other well-defined disease at the time of

arthroscopy (cohort 1), and an additional 53 patients were classified

after a full diagnostic reevaluation at 6 months (cohort 2). Synovial

parameters with diagnostic value were identified in cohort 1 and were

compared prospectively with classic diagnostic parameters in cohort 2.

RESULTS: Staining with anticitrulline, staining with monoclonal antibody

12A (recognizing HLA-DR shared epitope-human cartilage glycoprotein

39(263-275) complexes), and crystal deposition had positive predictive

values (PPVs) for diagnosis of >90% in patients with an atypical disease

presentation (cohort 2). Using these 3 parameters, a diagnosis was

predicted by synovial histopathology in 39.6% of cohort 2 patients and

turned out to be correct in 90.5% of these patients at 6 months of

followup. Using a multiparameter model rather than single

histopathologic parameters, even better results were obtained, with a

diagnostic prediction in 79.2% of samples and a PPV of 81.0%. In

comparison, a similar multiparameter model using classic diagnostic

criteria rather than synovial histopathology performed poorly in cohort

2; the sensitivity was 56.6% and the PPV was 73.3%, with an inferior

capacity to predict SpA. Especially for the presence of crystals and

anticitrulline staining, the analysis of synovial tissue had a clear

added value to the analysis of synovial fluid or serum in patients with

an atypical presentation.

CONCLUSION: This proof-of-concept study indicates that synovial

histopathology can contribute to the multiparametric diagnostic

classification of inflammatory arthritis in patients with an atypical

presentation.

PMID: 15457462

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5457462 & dopt=Abstract

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