Total area of inflammatory infiltrate and percentage of inflammatory infiltrate identify different clinical-serological subsets of primary Sjögren's syndrome better than traditional histopathological parameters.

OBJECTIVES: Recently, the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate have been proposed as novel histopathological parameters to improve the stratification of patients with Sjögren's syndrome (SS) in clinical trials. Both these parameters provide a more accurate assessment of the extent of the infiltrate in minor salivary gland biopsies (MSGBs) and may overcome the bias related to the Focus score (FS). To date, however, only few studies have investigated their clinical value and feasibility. In this study we revised consecutive MSGBs obtained routinely in a real-life clinical setting and correlated the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate both with the other MSGB histopathological parameters and with patients' clinical features in order to explore their usefulness in SS diagnostic work-up. METHODS: We assessed the area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in consecutive MSGBs and correlated these parameters with the number of foci, the FS and the presence of ectopic lymphoid structures (ELS). We also correlated these additional parameters with patients' clinical and biological data. RESULTS: We revised 69 MSGB samples: 46 from patients with a diagnosis of SS and 23 from subjects with no SS. The total area of inflammatory infiltrate and the percentage of inflammatory infiltrate appeared significantly higher in patients fulfilling the ACR/EULAR classification criteria for SS and correlated significantly with both the number of foci (p<0.001) and the FS (p<0.001). Particularly, they correlated better with the ELS in MSGBs than the number of foci and the FS. When we limited the analysis to the 32/69 patients with a FS<1, both the total area of the inflammatory infiltrate (p=0.02) and the percentage of the inflammatory infiltrate (p=0.03), but not the number of foci (p=0.12) remained significantly higher in the 10/32 anti-Ro/SSA positive patients fulfilling the ACR/EULAR classification criteria. Finally, the total area of inflammatory infiltrate and the percentage of inflammatory infiltrate correlated significantly with several biological and haematological SS-related abnormalities including hypergammaglobulinaemia, C4 levels, total number of white blood cells and the number of circulating lymphocytes. CONCLUSIONS: The total area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in SS referral centres, and particularly for selected cases, may maximise the information on disease activity at tissue level, ultimately improving SS patients' assessment.

One year in review 2018: axial spondyloarthritis.

Spondyloarthritis (SpA) is the umbrella term for a broad spectrum of inflammatory rheumatic diseases with typical but also rather different clinical manifestations, limited laboratory abnormalities and characteristic imaging features. For classification purposes, a so-called non-radiographic form (nr-axSpA) is differentiated from a radiographic one (r-axSpA) which is almost identical to the classical ankylosing spondylitis (AS) that is genetically strongly associated with the major histocompatibility complex class 1 antigen HLA-B27. In axSpA, the axial skeleton is affected by both inflammation and new bone formation, and joints might be affected. Rather typical musculoskeletal manifestations of SpA are enthesitis and dactylitis, the latter mainly in psoriatic arthritis (PsA). Extra-articular manifestations such as acute anterior uveitis (AAU), psoriasis (PsO) and inflammatory bowel disease (IBD) are also typical of SpA. In this paper we review the literature on axial SpA (ax-SpA) of 2018 (Medline search of articles published from 1st January 2018 to 31st January 2019).

One year in review 2018: psoriatic arthritis.

Spondyloarthritis (SpA) is an inflammatory condition characterised by a broad spectrum of clinical manifestations, laboratory abnormalities and imaging features that genetically tend to be associated with the major histocompatibility complex class 1 antigen, HLA-B27, and in which both peripheral and axial joints might be affected. In addition to arthritis, the typical musculoskeletal manifestations are enthesitis and dactylitis. Extraarticular manifestations such as acute anterior uveitis (AAU), psoriasis (PsO) and inflammatory bowel disease (IBD) are also typical of SpA. In this article we have reviewed the literature of the past year on one of the most important variants of SpA, i.e. psoriatic arthritis (PsA) (Medline search of articles published from 1st January 2018 to 31st January 2019).