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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.

Methods

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)

Results

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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