Inclusion of fibrinoid necrosis increases the accuracy of synovial tissue assessment in predicting response to methotrexate: analysis of the UCLouvain Brussels Early Rheumatoid Arthritis (ERA) Cohort
Authors' conclusion
FN and CD68 + in ERA synovial biopsies identify patients with higher disease activity and predict a better treatment response at three months.
Study context
- Population
- Early Rheumatoid Arthritis (RA) patients from the UCLouvain Arthritis Cohort undergoing synovial biopsy and starting Disease-Modifying Antirheumatic Drug (DMARD) therapy (Methotrexate (MTX))
- Participants
- 140 patients
- Exposure
- CD68NecrosisHIGH vs CD68NecrosisLOW synovial score
- Outcome
- Synovial predictive factors for treatment response to MTX
Methodological detailssynovial biopsy, histology and immunohistochemistry (IHC), semi-quantitative 0-3 scale
- Synovial biopsy
- Histology and IHC
- Semi-quantitative 0-3 scale
Main finding
As reported in the abstract
Fall in DAS28 (treatment response)
CD68NecrosisHIGH
1.99
SD 2.06
CD68NecrosisLOW
1.1
SD 2.27
P = 0.03
Observational data: associations, not effects.
Further findings
| Outcome | CD68NecrosisHIGH | CD68NecrosisLOW | R (CI) | P value |
|---|---|---|---|---|
| Fall in SDAI | 21.45 (IQR 23.3) | 11.65 (IQR 17.5) | P = 0.003 | |
| Fall in CDAI | 16 (spread (unspecified) 14.9) | 10.5 (spread (unspecified) 20.1) | P = 0.04 | |
| Pre-treatment disease activity · baseline | 5.48 (spread (unspecified) 1.6) | 4.8 (spread (unspecified) 1.7) | P = 0.03 | |
| Correlation of synovial CD68 and fibrinoid necrosis scoresCD68 score vs Fibrinoid Necrosis score | 0.44 (0.27–0.56) | P < 0.0001 |
Correlation of synovial CD68 and fibrinoid necrosis scores
- CD68 correlated with CRP, DAS28, SDAI and CDAI; Fibrinoid Necrosis (FN) score correlated with CRP and DAS28
Prediction model (CD68Necrosis score + SJC44 and DAS28) for Moderate/Good EULAR response · 3 months
- AUC
- 0.724
Original publication
Inclusion of fibrinoid necrosis increases the accuracy of synovial tissue assessment in predicting response to methotrexate: analysis of the UCLouvain Brussels ERA Cohort. Arthritis Res Ther. Published 19 August 2024. doi:10.
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