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Ann Rheum Dis. 2005 Apr; 64(4): 529–536.
Published online 2004 Sep 23. doi:  10.1136/ard.2003.018549
PMCID: PMC1755461

Histological evidence that infliximab treatment leads to downregulation of inflammation and tissue remodelling of the synovial membrane in spondyloarthropathy


Objective: To confirm and extend the immunopathological evidence of effects of infliximab on the synovium in active spondyloarthropathy.

Methods: Synovial biopsies obtained in patients with spondyloarthropathy at baseline and week 12 were stained and scored by two independent observers. Two study populations were evaluated: I, a cohort of 10 patients treated with 5 mg/kg infliximab at week 0, 2, and 6, plus three placebo treated patients; and II, a pooled cohort of 20 patients fulfilling identical inclusion and exclusion criteria and treated with the same loading dose regimen.

Results: In study population I, treatment with infliximab induced reduction in synovial lining layer thickness (p = 0.015), endothelial activation (E-selectin, p = 0.034), and inflammatory cell infiltration with neutrophils (p = 0.041), macrophages (p = 0.034), and T cells (p = 0.026), but not with B cells and plasma cells; no such trends were observed in the placebo treated patients. Besides confirming the highly significant downregulation of inflammation, analysis of cohort II showed structural changes such as normalisation of lining layer thickness (p = 0.030), reduction in the number of blood vessels (p = 0.039), and downregulation of follicular organisation (p = 0.050). No differences in histopathological response were observed between spondyloarthropathy subtypes.

Conclusions: Profound immunomodulatory changes in the synovium parallel the clinical benefit in patients with spondyloarthropathy treated with infliximab, independently of the subtype. The study provides histological evidence that TNFα blockade not only downregulates inflammation but also leads to tissue remodelling.

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Selected References

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Figures and Tables

Figure 1
 Immunomodulatory effect of infliximab (A = study population I, n = 10) or placebo (B = study population I, n = 3) on synovial histology in patients with active spondyloarthropathy. Synovial biopsies obtained at week 0 and week 12 were scored ...
Figure 2
 Tissue remodelling effect of infliximab (A = study population I, n = 10) or placebo (B = study population I, n = 3) on synovial histology in patients with active spondyloarthropathy. Synovial biopsies obtained at week 0 and week 12 were scored ...

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