Schmidt et al used the General Synovitis and Immunologic Synovitis Scores to evaluate synovitis activity in patients with rheumatoid arthritis. The authors are from University Medical Center Hamburg-Eppendorf, Nantes University Hospital, and the Institute of Pathology Trier.
Patient selection: rheumatoid arthritis (RA)
Parameters for the General Synovitis Score (Synovialitis Score of Krenn et al):
(1) enlargement of synovial lining cell layer
(2) cellular density of synovial stroma
(3) leukocyte infiltrate
|
Feature
|
Points
|
|
absent
|
0
|
|
mild
|
1
|
|
moderate
|
2
|
|
strong
|
3
|
general synovitis score =
= SUM(points for all 3 parameters)
Immunostains for Immunologic Synovitis Score:
(1) anti-CD3 (T cells)
(2) anti-CD20 (B cells)
(3) anti-CD15 (neutrophils, although may stain other inflammatory cells)
(4) anti-CD68 (macrophages)
(5) anti-Ki67
Area of count: 1.3 square mm
|
Infiltrate
|
Points
|
|
< 10 cells
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0
|
|
10 to 99 cells
|
1
|
|
100 to 999 cells
|
2
|
|
>= 1,000 cells
|
3
|
immunologic synovitis score =
= SUM(points for all 5 immunostains)
total score =
= (general synovitis score) + (immunologic synovitis score)
Interpretation:
• minimum scores: 0
• maximum general synovitis score: 9
• maximum immunologic synovitis score: 15
• maximum total score: 24
• A GSS >= 5 is associated with high-grade synovitis.
• Scores for CD3, CD15 and CD20 were associated with disease activity.
• The GSS and ISS generally reflect disease activity of rheumatoid arthritis in medically-treated patients.
