CASE REPORT - The effect of intra-articular Remicade on synovial membrane pathology in a patient with a seronegative spondyloarthropathy

[Guest guest]

Ann Rheum Dis. Published Online First: 13 April 2008.

doi:10.1136/ard.2008.090910

Copyright © 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

--------------------------------------------------------------------------------

Concise Report

The effect of intra-articular infliximab on synovial membrane

pathology in a patient with a seronegative spondyloarthropathy

M J Ahern 1, D G 1, H Weedon 1, V Papangelis 1 and M D 1*

1 Repatriation General Hospital, Australia

Abstract

Aim: To demonstrate the efficacy of intra-articular infliximab in a

patient with a persistent monoarthritis who had previously had two

arthroscopic synovectomies with limited success and the effect of

intra-articular infliximab on synovial membrane pathology.

Method: Arthroscopic synovial biopsies were collected before and after

treatment with intra-articular infliximab. The synovial tissue was

stained for a range of inflammatory cell subsets, cell adhesion

molecules and cytokines using immunohistochemical techniques and

quantified using digital image analysis and a semi-quantitative

scoring method.

Results: There was clinical improvement in the knee synovitis after

the first two intra-articular Infliximab treatments with a sustained

clinical remission lasting for more than 12 months after the third

intra-articular Infliximab treatment. There were significant changes

in cellular infiltration and expression of cytokines and cell adhesion

molecules as a result of treatment with intra-articular Infliximab

with a reduction in some but not all cells in the inflammatory

infiltrate, as well as a reduction in the expression of cell adhesion

molecules (ICAM-1 and VCAM-1) and production of cytokines (IL-1 and

TNF-).

Conclusion: Intra-articular Infliximab administration is a viable

treatment option for a persistent monoarthritis, resistant to other

treatment options and can successfully modulate the inflammatory

milieu within the synovial membrane.

--------------------------------------------------------------------------------

http://ard.bmj.com/cgi/content/abstract/ard.2008.090910v1?papetoc

--

Not an MD