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Ann Rheum Dis. Feb 2000; 59(2): 135–140.
PMCID: PMC1753076

Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis— cellularity correlates with the degree of enhancement detected by magnetic resonance imaging

Abstract

OBJECTIVE—Sacroiliitis is a hallmark of the spondyloarthropathies (SpA). The degree of inflammation can be quantified by magnetic resonance imaging (MRI). The aim of this study was to further elucidate the pathogenesis of SpA by quantitative cellular analysis of immunostained sacroiliac biopsy specimens and to compare these findings with the degree of enhancement in the sacroiliac joints (SJ) as detected by dynamic MRI.
METHODS—The degree of acute sacroiliitis detected by MRI after intravenous administration of gadolinium-DTPA was quantitatively assessed by calculating the enhancement observed in the SJ and chronic changes were graded as described in 32 patients with ankylosing spondylitis (n=18), undifferentiated SpA (n=12) and psoriatic arthritis (n=2). Back pain was graded on a visual analogue scale (VAS, 0-10) and disease duration (DD) was assessed. Shortly after MRI, SJ of patients with VAS > 5 were biopsied guided by computed tomography. Immunohistological examination was performed using the APAAP technique; only whole sections > 3 mm were counted.
RESULTS—By MRI, chronic changes [less-than-or-eq, slant] grade II were detected in nine patients (group I, DD 2.5 (SD 2.9) years) and > II in 13 patients (group II, DD 7.3 (SD 4.8) years), while enhancement < 70% was found in eight (group A, DD 5.6 (SD 3.3) years) and > 70% in 12 patients (group B, DD 4.7 (SD 5.8) years). The relative percentage of cartilage (78-93%), bone (7-18%) and proliferating connective tissue (1-4%) was comparable between the groups (range). There were more inflammatory cells in group I compared with group II (mean (SD) 26.7(20.1) versus 5.3 (5.2), p=0.04) and group A compared with B (21.8 (17.3) versus 6.0 (5.6), p=0.05) cells/10 mm2), T cells (10.9 (8.5)) being slightly more frequent than macrophages (9.6 (16.8/10 mm2)). Clusters of proliferating fibroblasts were seen in three and new vessel formation in seven cases.
CONCLUSION—This study shows that T cells and macrophages are the most frequent cells in early and active sacroiliitis in SpA. The correlation of cellularity and MRI enhancement provides further evidence for the role of dynamic MRI to detect early sacroiliitis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
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Figures and Tables

Figure 1
Detailed comparison of relative cell counts of sacroiliac biopsies between patients with different degrees of enhancement in MRI.
Figure 2  Figure 2
MRI and SJ biopsy specimen of a 16 year old HLA B27+ uSpA patient with unilateral IBP located in the left buttock. (A) T1 weighted gradient echo sequence five minutes after application of gadolinium-DTPA showing some chronic changes and definite ...
Figure 4  Figure 4
MRI and SJ biopsy specimen of a 17 year old female uSpA patient with unilateral inflammatory low back pain located to the right side and a disease duration of 1.5 years. (A) T1 weighted gradient echo sequence three minutes after application ...
Figure 5  Figure 5
MRI and SJ biopsy specimen of a HLA B27+ 16 year old male juvenile AS patient with bilateral inflammatory low back pain and a disease duration of 7.5 years. (B). T2* weighted gradient echo sequence showing bilateral chronic changes with ...
Figure 6  Figure 6
CT and SJ biopsy of a 28 year old female HLA B27+ AS patient with a disease duration of 4.9 years and severe IBP mainly right side. (A) CT showing definite chronic changes in the right SJ (chronicity grade III-IV, activity grade b, not ...
Figure 7  Figure 7
MRI and SJ biopsy specimen of a 36 year old female HLA B27+ AS patient with a disease duration of 10 years with bilateral inflammatory low back pain. (A) T2* weighted gradient echo sequence showing definite chronic changes with bilateral ...
Figure 3  Figure 3
MRI and SJ biopsy specimen of a 35 year old man HLA B27+ uSpA patient with a disease duration of 1.8 years and severe IBP. (A) STIR sequence showing definite acute changes in the right sacroiliac joint (chronicity grade I, activity grade ...

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