Synovitis Score

The synovitis score according to Veit Krenn and colleagues is a semi-quantitative histopathological evaluation mechanism for the diagnosis of rheumatic and non-rheumatic joint diseases . Here, the severity of the inflammation of the inner synovial membrane (technically synovitis or synovitis, inflammation of the synovial membrane ) is examined by the pathologist under the microscope.

indication

Many diseases of the joints in the diagnosis or to be therapy of orthopedic surgeons and rheumatologists , the inner joint skins removed or biopsied . To confirm the diagnosis, the doctor sends the tissue removed and fixed in formalin to the pathologist for histopathological assessment.

application

To perform the synovitis score, the pathologist uses standard tissue sections that have been stained with HE and a light microscope .

The pathologist examines the three histological compartments of synovitis,

• the synovial cover cell layer , which borders the joint space
• the synovial stroma with the connective tissue cells and capillaries located there
• the immigration of leukocytes (inflammatory cells, white blood cells)

and awards semiquantitative points for the characteristics of each of the three compartments

• 0 = normal
• 1 = slightly changed
• 2 = moderately changed
• 3 = severely changed

Finally the three values ​​are added. This results in values ​​for the synovitis score from 0 to 9.

evaluation

The level of the synovitis score gives the pathologist information about the severity of the inflammation of the inner synovial membrane and, based on the clinical information provided by the doctor sending the patient, allows conclusions to be drawn about the underlying disease.

It is important to distinguish between low-grade synovitis (0–4 points) and high-grade synovitis (5–9 points), which enables a statement to be made about the cause of the inflammation.

If the pathologist detects high-grade synovitis , there is a high probability that a primary inflammatory joint disease from the rheumatic group is present ( sensitivity : 73%, specificity : 86%). This includes, for example

• the rheumatoid arthritis (chronic polyarthritis)
• the arthritis of psoriasis (psoriatic arthritis)
• the arthritis in borreliosis
• the ankylosing spondylitis
• The reactive arthritis .

If there is low-grade synovitis , this indicates a reaction of the inner synovium to a degenerative joint disease in the context of osteoarthritis , meniscopathy or after trauma .

relevance

The result of the synovitis score is sent to the sending doctor by the pathologist within a few days with the rest of the histological assessment. If clinical information about the patient is available, the pathologist is able to evaluate and comment on the suspected diagnosis using the synovitis score. For example, the further therapy of the patient is based on this, which enables a targeted and effective treatment of the underlying disease.

Validation

The synovitis score has been examined in various studies for its accuracy and informative value and has proven to be a reliable, inexpensive and quick diagnostic tool.

In a large study, two independent pathologists, without knowing the patient's clinical diagnosis, assessed 483 tissue samples. The results of the two investigators correlated significantly (p <0.001). When the same tissue samples were examined several times, the investigators achieved the same result in approx. 90%. Significantly higher synovitis scores were determined for chronic inflammatory diseases than for degenerative joint diseases.

In another study, a correlation of the synovitis score in rheumatoid arthritis with the marker Ki67, CD68-positive macrophages, and with MMP-9 was demonstrated.

A computer-aided validation of the synovitis score showed that between an examining pathologist and a computer-aided image evaluation program the deviation of the determined score was not more than one score point up or down in more than half of the cases.

Individual evidence

1. ^ V. Krenn et al .: Synovitis score: discrimination between chronic low-grade and high-grade synovitis. In: Histopathology 49, 2006, pp. 358-364. PMID 16978198
2. ↑ ^{a b} V. Krenn et al .: Grading of chronic synovitis - a histopathological grading system for molecular and diagnostic pathology. In: Pathol Res Pract 198, 2002, pp. 317-325. PMID 12092767
3. ^ V. Krenn et al .: Synovitis Score: Histopathological grading scheme for rheumatic and non-rheumatic synovitis. In: Z Rheumatol 64, 2005, pp. 334-342. PMID 15965818
4. ^ ^{A b} I. Berger et al.: Importance of the histological diagnosis of synovial diseases. In: Der Orthopäde 38, 2009, pp. 484–490. doi : 10.1007 / s00132-008-1396-0 PMID 19458935 .
5. ↑ M. Jakobs et al.: Synovitis score: value of histopathological diagnosis in unclear arthritis. In: Z Rheumatol 66, 2007, pp. 706-712. doi : 10.1007 / s00393-007-0232-y PMID 18000669 .
6. ↑ F. Pessler et al.: Subintimal Ki-67 as a synovial tissue biomarker for inflammatory arthropathies. In: Ann Rheum Dis 67, 2008, pp. 162-167. PMID 17613556
7. ↑ M. Jakobs et al.: MMP- and FAP-mediated, inflammation-independent destruction of bones and cartilage in rheumatoid arthritis. In: Z Rheumatol 68, 2009, pp. 683-694. doi : 10.1007 / s00393-009-0461-3 . PMID 19593575 .
8. ↑ L. Morawietz et al: Computer-assisted validation of the synovitis score. In: Virchows Arch 452, 2008, pp. 667-673. PMID 18283490

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !