DIAGNOSTIC VALUE OF ARTHROSCOPY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Abstract

29 children with monoarthiritis were included in our study. Besides routine clinical and laboratorial examination, knee arthroscopy with synovial biopsy was performed in all patients. Visual examination of synovial hyperplasia and hyperemia and microscopic examination was performed. Patients were divided into 2 groups with primary and secondary (associated with joint traumatic damage) synovitis. Patients with primary synovitis had significantly lower disease onset age, lower hemoglobin level and higher ESR and CRP and disease duration compare with secondary synovitis group. Intensive and very intensive type of synovial hyperplasia more frequently in first group, in second group more frequently mild and moderate type of synovial hyperplasia occurred. Correlation between synovial hyperplasia and hyperemia has been revealed (r=0,72, p<0,000), between hyperplasia and type of hyperplasia (r=-0,55, p<0,000), and between hyperplasia and arthritis course (r=0,42, p=0,04) was noted in primary synovitis and no any correlation in secondary synovitis. Hyperplasia stage correlated with progressive disease course (r=0,44, p<0,05) and degree with X-ray stage (r=0,48, p<0,05) in primary sinovitis. Conclusions: arthroscopy with synovial biopsy has been suggested in children with chronic monoarthritis without inflammatory activity.

Keywords

knee monoarthiritis / synovial membrane / arthroscopy

References

[1] 1. Каратеев, Д.Е. Синовиальная оболочка на ранней стадии ревматоидного артрита: клинико-морфологические сопоставления / Д.Е. Каратеев, С.Г. Раденска-Лоповок, В.А. Насонова, М.М. Иванова // Тер. архив. – 2003. – № 5. – С. 12–20.

[2] 2. Лялина, В.В. Артроскопия и морфология синовитов / В.В. Лялина, А.Б. Шехтер. – М. : Наука, 2007. – 108 с.

[3] 3. Baeten, D. Comparative study of the synovial histology in rheumatoid arthritis, spondyloarthropathy, and osteoarthritis: influence of disease duration and activity / D. Baeten [et al.] // Ann. Rheum. Dis. – 2000. – Vol. 59. – P. 945–953.

[4] 4. Baeten, D. Needle arthroscopy of the knee with synovial biopsy sampling: technical experience in 150 patients / D. Baeten [et al.] //Clin. Rheum. – 1999. – Vol. 18. – P. 434–441.

[5] 5. Baeten, D. Infiltation of the synovial membrane with macrophage subsets and polymorphonuclear cells reflects global disease activity in spondyloarthropathy / D. Baeten [et al.] // Arthritis Res. Ther. – 2005. – Vol. 7. – P. 359–369.

[6] 6. Canete, J.D. Diagnostic usefulness of synovial vascular morphology in chronic arthritis: A systematic survey of 100 cases / J.D. Canete [et al.] // Semin. Arthr. Rheum. – 2003. – Vol. 32, N 6. – P. 378–387.

[7] 7. Cassidy, J.T. Textbook of Pediatric Rheumatology / J.T. Cassidy, R.E. Petty, R.M. Laxer, C.B. Lindsley. – 5th ed. – Philadelphia : W.B. Saunders, 2005.

[8] 8. Farahat, M.N. Cytokine expression in synovial membranes of patients with rheumatoid arthritis and osteoarthritis / Farahat M.N. [et al.] // Ann. Rheum. Dis. – 1993. – Vol. 52. – P. 870–875.

[9] 9. Fiocco, U. Vascular changes in psoriatic knee joint synovitis / U. Fiocco, L. Cozzi // J. Rheumatol. – 2001. – Vol. 28, N 11. – P. 2480–2486.

[10] 10. Konig, A. et al. Inflammatory infiltrate and interleukin-8 expression in the synovium of psoriatic arthritis: an immunohistochemical and mRNA analysis / A. Konig [et al.] // Rheumatol. Int. – 1997. – Vol. 17. – P. 159–168.

[11] 11. Kraan, M.C. et al. Immunohistological analysis of synovial tissue for differential diagnosis in early arthritis / M.C. Kraan [et al.] // Rheumatolodgy. – 1999. – Vol. 38. – P. 1074–1080.

[12] 12. Kruithof, E. Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis. E. Kruithof [et al.] // Arthritis Res. Ther. – 2005. – Vol. 7. – P. 569–580.

[13] 13. Lindblad, S. Intraarticular variation in synovitis – local macroscopic and microscopic signs of inflammatory activity are significantly correlated / S. Lindblad, E. Hedfors // Arthr. Rheum. –1985. – Vol. 28. – P. 977–986.

[14] 14. Lindqvist, E. Cartilage macromolecules in knee joint synovial fluid. Markers of the disease course in patients with acute oligoarthritis / E. Lindqvist, T. Saxne // Ann. Rheum. Dis. – 1997. – Vol. 56. – P. 751–753.

[15] 15. Nistala, K. Interleukin-17-Producing T cells are enriched in the joints of children with arthritis, but have a reciprocal relationship to regulatory T cell numbers / K. Nistala [et al.] // Arthr. Rheum. – 2008. – Vol. 3. – P. 875–887.

[16] 16. Paus, A.C. Arthroscopic evaluation of the synovial lining before and after open synovectomy of the knee joint in patients with chronic inflammatory joint diseases / A.C. Paus, J.A. Pahle // Scand. J. Rheumatol. – 1990. – Vol.19. – P. 193–201.

[17] 17. Tchetverkov, I. MMP profile in paired serum and synovial fluid samples of patients with rheumatoid arthritis / I. Tchetverkov [et al.] // Ann. Rheum. Dis. – 2004. – Vol. 63. – P. 881–883.

[18] 18. Zschabitz, A. Correlative histologic and arthroscopic evaluation in rheumatoid knee joints / A. Zschabitz, M. Neurath // Surg. Endosc. – 1992. – Vol. 6. – P. 277–282.