PT  - JOURNAL ARTICLE
AU  - Allen Anandarajah
AU  - Ralf Thiele
AU  - Ellen Giampoli
AU  - Johnny Monu
AU  - Gwy-Suk Seo
AU  - Changyong Feng
AU  - Christopher T. Ritchlin
TI  - Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies
AID  - 10.3899/jrheum.140411
DP  - 2014 Nov 01
TA  - The Journal of Rheumatology
PG  - 2153--2160
VI  - 41
IP  - 11
4099  - http://www.jrheum.org/content/41/11/2153.short
4100  - http://www.jrheum.org/content/41/11/2153.full
SO  - J Rheumatol2014 Nov 01; 41
AB  - Objective. The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology. Methods. We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined. Results. Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US. Conclusion. Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.