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The relationship between synovial lymphocyte aggregates and the clinical response to infliximab in rheumatoid arthritis: A prospective study
Arthritis & Rheumatism, 11/04/09

Klassen R et al. – RA patients with synovial lymphocyte aggregates have, on average, a better response to infliximab treatment than those with only diffuse leukocyte infiltration. Moreover, the aggregation of synovial lymphocytes is reversible after anti-TNF antibody treatment.

• Synovial tissue biopsy samples were obtained from 97 patients with active RA before the initiation of infliximab treatment
• The effects of TNF blockade on lymphocyte aggregates were compared between patients with RA and patients with psoriatic arthritis (PsA)

• Fifty-seven percent of RA synovial tissue samples contained lymphocyte aggregates, and 32% of the patients had large aggregates
• Aggregates were found in 67% of clinical responders compared with 38% of nonresponders
• The presence of aggregates at baseline was a highly significant predictor of the clinical response to anti-TNF treatment
• Positivity for lymphocyte aggregates increased the power to predict the clinical response, when analyzed in a prediction model that included baseline disease activity evaluated by the Disease Activity Score in 28 joints, anti-cyclic citrullinated peptide antibody positivity, and synovial TNF expression
• There was a reduction in lymphocyte aggregates after anti-TNF antibody therapy in both RA and PsA

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