Studies of the synovial membrane in chronic rheumatic joint disease

University dissertation from Stockholm : Karolinska Institutet, Department of Medicine

Abstract: Background: The synovial membrane (SM) outlines the inner cavity of synovial joints except for cartilage surfaces. The SM is the target organ of immune-mediated responses in chronic arthritis, including rheumatoid arthritis (RA). RA is a common joint disease (prevalence of 0.5-1.0%) which is characterized by recurrent joint inflammation, with increasing joint damage and disability. The study of the SM in vivo provides important information about disease pathogenesis and response to treatment. The aim of this thesis was to study a method for biopsy retrieval, arthroscopy, SM variation by gene and protein expression and SM response to anti-rheumatic therapy. Results: ' In these studies we have added to existing evidence that arthroscopy is a safe and reliable method for synovial tissue retrieval. ' We have constructed and validated an easy to use macroscopic score for arthroscopy. This score needs validation against other methodologies. ' We have studied variability of synovial gene expression, where we could see that samples close to one another were more related than samples further apart, especially from other patients. Arthroscopic biopsies had less intrinsic variation than had orthopaedic material. ' We have shown that injection of intra articular glucocorticosteroids (GCs) reduces protein expression of synovial proinflammatory molecules (TNF, IL-1

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