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Abstract：
OBJECTIVE: This study investigates the diagnostic role of synovial tissue analysis in children presenting with arthritis and assesses its prognostic significance to predict clinical outcome in juvenile idiopathic arthritis (JIA).
METHODS: Synovial samples of paediatric patients undergoing synovial biopsy between 1995 and 2020 were analysed histologically and immunohistochemically. Relationships between histological/immunohistochemical parameters and clinical variables were assessed.
RESULTS: Synovial biopsy was performed for diagnosis in 65 cases allowing to correctly classify 79% of patients.At histological analysis on 42 JIA samples, any difference in the number of synovial lining layers, subsynovial elementary lesions, fibrin deposit, Krenn Synovitis Score, inflammatory infiltrate score and pattern emerged between JIA subsets or on treatment exposure. Synovial tissue analysis predicted outcome: higher number of synovial layers predicted worse disease course (>4 flares during follow-up; 4.5 vs 3.0, p=0.035), even after adjusting for age at diagnosis and observation time (OR 2.2, p=0.007); subjects who had switched>2 biological disease-modifying antirheumatic drugs had higher prevalence of subsynovial elementary lesions (55.6% vs 10.3%, p=0.005) and fibrin deposits in synovial lining (60.0% vs 22.6%, p=0.049), even after adjustment for observation time and age at diagnosis (OR 8.1, p=0.047). At immunohistochemistry on 31 JIA samples, higher CD3 expression was described in polyarticular compared with oligoarticular subset (p=0.040). Patients with severe disease course had higher CD20+ rate (OR 7, p=0.023), regardless of JIA subset and treatment exposure.
CONCLUSIONS: Synovial tissue analysis might support the clinicians in the diagnostic approach of paediatric patients presenting with arthritis and guide the clinical management in JIA.
METHODS: Synovial samples of paediatric patients undergoing synovial biopsy between 1995 and 2020 were analysed histologically and immunohistochemically. Relationships between histological/immunohistochemical parameters and clinical variables were assessed.
RESULTS: Synovial biopsy was performed for diagnosis in 65 cases allowing to correctly classify 79% of patients.At histological analysis on 42 JIA samples, any difference in the number of synovial lining layers, subsynovial elementary lesions, fibrin deposit, Krenn Synovitis Score, inflammatory infiltrate score and pattern emerged between JIA subsets or on treatment exposure. Synovial tissue analysis predicted outcome: higher number of synovial layers predicted worse disease course (>4 flares during follow-up; 4.5 vs 3.0, p=0.035), even after adjusting for age at diagnosis and observation time (OR 2.2, p=0.007); subjects who had switched>2 biological disease-modifying antirheumatic drugs had higher prevalence of subsynovial elementary lesions (55.6% vs 10.3%, p=0.005) and fibrin deposits in synovial lining (60.0% vs 22.6%, p=0.049), even after adjustment for observation time and age at diagnosis (OR 8.1, p=0.047). At immunohistochemistry on 31 JIA samples, higher CD3 expression was described in polyarticular compared with oligoarticular subset (p=0.040). Patients with severe disease course had higher CD20+ rate (OR 7, p=0.023), regardless of JIA subset and treatment exposure.
CONCLUSIONS: Synovial tissue analysis might support the clinicians in the diagnostic approach of paediatric patients presenting with arthritis and guide the clinical management in JIA.
摘要：
目的：本研究探讨滑膜组织分析在儿童关节炎中的诊断作用，并评估其预后意义，以预测幼年特发性关节炎（JIA）的临床结局。
方法：对1995年至2020年间接受滑膜活检的儿科患者的滑膜样本进行组织学和免疫组织化学分析。评估了组织学/免疫组织化学参数与临床变量之间的关系。
结果：对65例患者进行滑膜活检诊断，使79%的患者能够正确分类。在42个JIA样本的组织学分析中，滑膜内衬层数量的任何差异，滑膜下基本病变，纤维蛋白沉积，Krenn滑膜炎评分,JIA亚群之间或治疗暴露时出现炎症浸润评分和模式.滑膜组织分析预测结果：滑膜层数较高预测病程较差（随访期间>4次发作；4.5vs3.0，p=0.035），即使在诊断和观察时间调整了年龄（OR2.2，p=0.007）；切换了>2种生物学疾病缓解抗风湿药的受试者滑膜下基本病变的患病率更高（55.6％vs10.3％，p=0.005）和滑膜衬里中的纤维蛋白沉积（60.0％vs22.6％，p=0.049),即使调整了诊断时的观察时间和年龄（OR8.1，p=0.047）。在31个JIA样本的免疫组织化学中，与少关节亚群相比,多关节亚群中的CD3表达更高(p=0.040).病程严重的患者CD20+发生率较高(OR7,p=0.023),无论JIA子集和治疗暴露。
结论：滑膜组织分析可能支持临床医生对出现关节炎的儿科患者的诊断方法，并指导JIA的临床管理。
方法：对1995年至2020年间接受滑膜活检的儿科患者的滑膜样本进行组织学和免疫组织化学分析。评估了组织学/免疫组织化学参数与临床变量之间的关系。
结果：对65例患者进行滑膜活检诊断，使79%的患者能够正确分类。在42个JIA样本的组织学分析中，滑膜内衬层数量的任何差异，滑膜下基本病变，纤维蛋白沉积，Krenn滑膜炎评分,JIA亚群之间或治疗暴露时出现炎症浸润评分和模式.滑膜组织分析预测结果：滑膜层数较高预测病程较差（随访期间>4次发作；4.5vs3.0，p=0.035），即使在诊断和观察时间调整了年龄（OR2.2，p=0.007）；切换了>2种生物学疾病缓解抗风湿药的受试者滑膜下基本病变的患病率更高（55.6％vs10.3％，p=0.005）和滑膜衬里中的纤维蛋白沉积（60.0％vs22.6％，p=0.049),即使调整了诊断时的观察时间和年龄（OR8.1，p=0.047）。在31个JIA样本的免疫组织化学中，与少关节亚群相比,多关节亚群中的CD3表达更高(p=0.040).病程严重的患者CD20+发生率较高(OR7,p=0.023),无论JIA子集和治疗暴露。
结论：滑膜组织分析可能支持临床医生对出现关节炎的儿科患者的诊断方法，并指导JIA的临床管理。
