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New Aspects in Joint and Bone Processes in Psoriatic Arthritis (PSA)

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Sestre Milosrdnice University hospital and Institute of Clinical Medical Research; [email protected]
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Disciplines
  • Medicine

Abstract

07 supplement.p65 Acta Clin Croat, Vol. 42, No. 2, 2003 133 Fassbender H. G. New aspects in joint and bone processes in psoriatic arthritis (PSA) NEW ASPECTS IN JOINT AND BONE PROCESSES IN PSORIATICARTHRITIS (PSA) Hans Georg Fassbender Zentrum Für Rheuma-Pathologie, Mainz, Germany Corresponding to the clinical-radiological peculiaritiesPSA demonstrates also a morphological profile which di-verges from other joint diseases. Following our observationsmorphological characteristics are found in synovial tissueas well as in joint cartilage and juxta-articular bone.In contrast to the alterations in rheumatoid arthritis(RA) and osteoarthrosis (OA), the following morphologi-cal features are characteristic for PSA: the synovial villi arelonger and thinner. Depending on the actual inflammato-ry activity, the lining cells may be either high-cylindricaland multi-layered or inconspicuously flat and single-lay-ered. A multi-layered proliferation of the lining cells is tran-sitory and merely an expression of an actual but uncharac-teristic inflammatory reaction which is observable in ev-ery joint disease. The fibrosis of villous stroma is denserthan in OA but not as compact as in RA. From our obser-vations, the pattern of vascularization is the most reliablefeature1,2. Within the synovial stroma, mainly in the periph-ery, closed to the lining cell layer, there is an unusually highnumber of narrow, thin-walled blood vessels (Fig. 1). These can best be seen in the early stages of synovitis. We pre-sume that after each episode of inflammation these ves-sels disappear due to the ensuing increased density ofcollagen fibres. Thus, diagnosis becomes more difficult.Danning and his co-workers3 believe that increased expres-sion of alphavbeta3 integrin is one explanation for theneovascularization in early phases of PSA. Fearon and hisco-workers4 believe that the increase in blood vessels in thevilli, compared to patients with RA, is due to higher levelsof TGFB-1 and increased VEGF expression in the synovialmembra

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