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Increased angiogenesis and cellular proliferation as hallmarks of the synovium in chronic septic arthritis
Arthritis Care and Research , 08/01/08

Pessler F et al. - This first analysis of the synovium in patients with chronic pyogenic arthritis identified dramatic neovascularization and cell proliferation, accompanied by persistent bacterial colonization and heterogeneous inflammatory infiltrates rich in CD15+ neutrophils, as histopathologic hallmarks.

Methods

Study to characterize histologic alterations and inflammatory infiltrates in the synovium of pts with chronic septic arthritis (SeA)
Synovial membranes from pts with SeA were compared with specimens from pts with septic joint prosthesis loosening, RA, OA, and normal histology
Sections were stained for von Willebrand factor, Ki-67, CD15, CD3, CD20, CD38, and CD68

Results

Gram stains were positive in all SeA and SeTA specimens
Mixed polymorphonuclear and mononuclear infiltrates predominated in SeA and SeTA
SeA could be differentiated from RA by higher densities of CD15+ cells or Ki-67+ cells
The inflammatory infiltrate of SeTA was similar to SeA but contained fewer CD3+ cells and a tendency toward fewer CD20+ cells
Mean vascular density was strikingly increased in SeA and, to a lesser extent, in the vascularized areas of the SeTA specimens
Ki-67/CD31 double immunostains demonstrated proliferating endothelial cells in small subintimal blood vessels, suggesting angiogenesis
Receiver operating characteristic curve analysis identified higher densities of CD15+ and Ki-67+ cells and vWF-positive vessels as histologic markers that differentiated SeA from RA

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