Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Giant Cell Tumor of Synovial Sheath: Of Two Cases Treated with Intra-Articular Infiltration of Infliximab.
Praino, Emanuela, Scioscia, Crescenzio, Anelli, Maria Grazia, Coladonato, Laura, Covelli, Michele, Iannone, Florenzo, Lapadula, Giovanni
The giant cell tumor of the synovial membrane, formerly called pigmented villonodular synovitis, is a rare disease, often resistant to conventional therapy and with frequent recurrence after synovectomy.
We report the case of two women aged 47 and 51 years, both with a diagnosis of giant cell tumor of the synovial membrane of the left knee, resistant to therapy with methotrexate and/or surgery. Infliximab was administered to both, by intra-articular injection with in-line filter, at a dose of 100 mg (diluted in 10 cc of saline) at time 0, 4 and 12 weeks. At each visit blood tests, clinimetric and Power Doppler ultrasound evaluations were performed. MRI was performed at baseline and four weeks after the last Infliximab injection.
At baseline, hyperplastic synovitis was noted by ultrasound for both patients, with power-Doppler signal of grade 2 and grade 3, these findings correlated with MRI results. At 4 weeks after the third administration, complete remission was noted with reduction of the thickening of the synovial membrane and a complete absence of power-Doppler signal. These findings were also confirmed by MRI. Both patients, therefore, were referred to an orthopedic specialist for a radical synovectomy. Two months after surgery, the patients had no recurrence of the tumor. No adverse events were noted.
The giant cell tumor of the synovial membrane, if untreated, can lead to disability. Synovectomy, possibly followed by radiosynovectomy, is the usual treatment of choice. Nevertheless, the recurrence of the tumor in approximately 50% of patients treated surgically indicates that surgery is not always sufficient. Our study confirms previous literature data reporting the effectiveness of infliximab, given intra articularly, in the treatment of giant cell tumor and showing a significant reduction In the number of macrophages and TNF-alpha expression in synovial tissue. Thus, this treatement is particularly effective in reducing inflammation and hyperplasia of the synovial membrane and prepare the joint for radical synovectomy surgery. Further studies are warranted to evaluate the long term efficacy and safety of infliximab in treatement of the giant cell tumor of the synovial membrane and whether this terapy may replace synovectomy.
To cite this abstract, please use the following information:
Praino, Emanuela, Scioscia, Crescenzio, Anelli, Maria Grazia, Coladonato, Laura, Covelli, Michele, Iannone, Florenzo, et al; Giant Cell Tumor of Synovial Sheath: Of Two Cases Treated with Intra-Articular Infiltration of Infliximab. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1047