Increased cellularity and expression of adhesion molecules in muscle biopsy specimens from patients with rheumatoid arthritis with clinical suspicion of vasculitis
buy canada goose jacket cheap Patrick C Verschuerena,d, Alexandre E Voskuylb, T J Smeetsc, Koos H Zwindermana, Ferdinand C Breedvelda, Paul P TakcMETHODS Three groups of patients with RA were studied: (a) without clinical signs of vasculitis (n=6); (b) with recent onset of extra articular features and a clinical suspicion of vasculitis but normal routine histology (n=11); and (c) with recent onset of extra articular features and vasculitis, canada goose outlet phone number histologically proved either canada goose outlet real in muscle or other biopsy specimens (n=14). A control group of patients with canada goose outlet winnipeg address osteoarthritis was also included (n=5). Frozen sections from quadriceps muscle biopsy specimens were analysed with monoclonal antibodies to detect CD3, CD4, CD8, CD68, ICAM 1, VCAM 1, and canada goose sale uk HLA DR. buy canada goose jacket cheap
The sensitivity for the diagnosis vasculitis is limited (13owing to the segmental distribution of the histological abnormalities and, usually, the restricted organ involvement.12 The diagnostic yield of muscle samples can be improved by examining multiple biopsy sections and by using new diagnostic criteria for vasculitis, such as the presence of perivascular infiltrates of more than three cell layers. Firstly, patients without any clinical sign of vasculitis were included. In this so called “RA” group the mean age of the six patients with RA was 72 years, with a mean disease duration of 12 years. Rheumatoid factors were detectable in five out of six, all had erosive disease, and none had subcutaneous nodules. Four of the patients in this group were treated with disease modifying antirheumatic drugs (DMARDs) (three sulfasalazine, one methotrexate) and one patient used prednisone (13 mg/d).
cheap canada goose uk Secondly, patients with recent canada goose outlet legit onset of extra articular features ( cheap canada goose uk
Thirdly, patients with recent onset of extra articular features and histological proof of vasculitis were included. This so called rheumatoid vasculitis (“RV”) group consisted of 14 patients with RA with a mean age of 71 years and a mean disease duration of 15 canada goose factory outlet toronto location years.
canada goose All patients were rheumatoid factor positive, most of them had erosive disease (13/14), and a majority had subcutaneous nodules (9/14). In this group eight of 14 patients used DMARDs (six sulfasalazine and three hydroxychloroquine) and four of 14 used prednisone (three hotcanadagoose.com 10 mg/d, one 40 mg/d). In the subgroup of patients in which vasculitis was proved by quadriceps muscle biopsy (n=7), the mean swollen joint count was 7.4 (SD 4.4) and the tender joint count 8.7 (SD 6.7). In the subgroup of patients (n=7) with histological confirmation of vasculitis in other biopsy specimens, the mean swollen joint count was 10 (SD 2.5) and the mean tender joint count 9.3 (SD 3.0). canada goose
The extra articular manifestations of RA were mainly nailfold lesions, purpura, cutaneous ulcers, and distal sensorimotor or sensory polyneuropathy. Weight loss was a common extra articular feature, but it was almost always accompanied by other canada goose outlet extra articular manifestations of RA. Table 1 gives details of the extra articular manifestations of the individual patients. In addition to the RA control group, five patients with osteoarthritis (OA) with a mean age of 67 years were recruited.
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canada goose uk outlet Characteristics of the individual patients with rheumatoid arthritis (RA) and extra articular manifestations, including the sites at which biopsy samples were taken and whether vasculitis was present (+) or absent () in these specific histological samplesPatients with RA were assigned to the different subgroups according to the results of an extensive conventional histological investigation on paraffin embedded tissue before, canada goose outlet official and independently of, the immunohistological analysis on frozen sections, which is the subject of this study.14 For this purpose a full thickness (skin/muscle/fascia) biopsy specimen of the quadriceps muscle was examined in all patients. Quadriceps muscle biopsy samples in the control groups were obtained during surgery for total hip replacement or knee arthroplasty. In most of the patients with RA suspected of vasculitis an additional tibial muscle biopsy specimen was examined (table 1). canada goose uk outlet
canada goose clearance The presence of vasculitis was considered proved when fibrinoid necrosis of the vessel canada goose outlet in montreal wall was shown by extensive histological examination after staining with haematoxylin and eosin, either in a quadriceps muscle or a tibialis muscle biopsy specimen. canada goose clearance
canadian goose jacket In the absence of fibrinoid necrosis in the first series of sections, a total of 45 sections for each muscle biopsy sample was examined to allow optimal classification by avoiding false negative test results due to discontinuous distribution of the lesions. If no vasculitis was seen according to the conventional criteria in either muscle biopsy specimen, a sural nerve biopsy was done to confirm the diagnosis in patients with peripheral neuropathy, with suggestive electromyographic abnormalities of the sural nerve. Furthermore, a skin biopsy was performed in all patients with a skin canada goose outlet las vegas rash to confirm or exclude the diagnosis of cutaneous vasculitis (table 1). All quadriceps muscle biopsy specimens were also evaluated for the presence of perivascular infiltrates, defined as the presence of at least three layers of mono/polymorphonuclear cells, around at least 50% of the circumference of a vessel wall.8 canadian goose jacket.