Decreased CD20 expression in rheumatoid arthritis synovium following 8 weeks of rituximab therapy.

Abstract:

OBJECTIVE:To characterise the effects of rituximab on synovial tissue of patients with refractory rheumatoid arthritis (RA). METHODS:Arthroscopic biopsy of knee joint synovium was performed on 6 patients with seropositive RA prior to commencing rituximab. Four patients underwent repeat biopsy eight weeks following completion of their rituximab infusion schedule. Cryostat sections of synovium were prepared and stained with mouse monoclonal specific antibodies including CD20, plasma cell antibody and CD68. RESULTS:Eight weeks after treatment mean DAS28 fell from 6.6+/-0.43 to 4.7+/-0.49 (p=0.068). Mean CRP fell from 86.7+/-27 mg/L to 20.5+/-7 mg/L (p<0.05). Subsynovial CD20+ B cells were demonstrated in all six patients at baseline. B cells were completely depleted in two patients at follow-up biopsy. Complete depletion was associated with excellent clinical response. No change in subsynovial B cells was seen in one patient. One patient's follow-up arthroscopy yielded inadequate tissue. A reduction was also seen in subsynovial plasma cells and CD68+ cells after treatment. CONCLUSION:B cells were present in synovial tissue of all patients with refractory RA. Complete depletion of B cells was associated with an excellent clinical response. These preliminary results suggest that early depletion of synovial B cells precedes a decrease in local inflammation leading to clinical improvement.

journal_name

Clin Exp Rheumatol

authors

Walsh CA,Fearon U,FitzGerald O,Veale DJ,Bresnihan B

subject

Has Abstract

pub_date

2008-07-01 00:00:00

pages

656-8

issue

4

eissn

0392-856X

issn

1593-098X

pii

2404

journal_volume

26

pub_type

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