Preliminary Study On The Feasibility Of Arthroscopic Synovectomy And Transplantation Of Regulatory B Cells In Treatment For Knee Synovitis With Rheumatoid Arthritis

Rheumatoid arthritis(RA)is a common autoimmune disease.When body is injured,human cells produce inflammatory substances,which activate B cells and T cells,leading to the release of autoantibodies and pro-inflammatory cytokines.As a result,it causes invasive synovitis or persistent autoimmune inflammation,leading to cartilage damage,bone erosion and decalcification around the joints.The knee joint is one of the most frequently affected joints.Knee synovitis with rheumatoid arthritis often cause discomfort,pain and dysfunction.This study will be divided into the following two parts to discuss.First,we'll discuss the clinical efficacy of knee synovitis with rheumatoid arthritis treated by arthroscopic surgery with five approaches.Second,we'll talk about the feasibility of transplantation of regulatory B cells in the treatment of knee synovitis with rheumatoid arthritis and the subsequent experimental design.Part I Arthroscopic synovectomy with five approaches for knee synovitis with rheumatoid arthritisObjective:To study the clinical efficacy of arthroscopic synovectomy with five approaches for knee synovitis with rheumatoid arthritis,and whether the postoperation drainage will make a difference to the treatment.Methods:36 patients(Steinbrocker stage ?????)were involved in this study,who underwent arthroscopic synovectomy from January 2014 to December 2015.All patients were followed up for at least 12 months(range,12 to 18 months).There were 13 males,23 females;22 were affected in left knee and 14 were in right(none of them were affected in both sides);mean age 47.2 years range(29 to 68 years).And they were divided in to two groups(with or without postoperation drainage)randomly for case control study.Then we compared the clinical efficacy of two groups by HAQ(Health Assessment Questionnaire),DAS28(Disease Activity Score 28)and Lysholm Rating Scale.Results:(1)A11 the scores of two groups at 6 weeks,3 months,1 year after operation shows no significant difference,which means drainage makes little influence.(2)The score of DAS28 and Lysholm Rating Scale for all these patients show significant difference between preopreration and one year after operation,which means arthroscopic synovectomy could obviously improve RA disease activity and function of the knee for Steinbrocker stage ?????.(3)For Steinbrocker stage ?,the score of HAQ shows significant difference between preopreration and one year after operation in all patients.However,the score of HAQ shows significant difference between preopreration and one year after operation only for some patients of Steinbrocker stage ???.That means arthroscopic synovectomy can significantly improve the quality of daily life for stage I,but improve only for some patients of stage ???.Conclusions:(1)For patients of Steinbrocker stage ????? who underwent arthroscopic synovectomy with five approaches,if hemostasis after synovectomy is thoroughly,postoperation drainage is not necessary.(2)For patients of Steinbrocker stage????? who underwent arthroscopic synovectomy with five approaches,surgery can obviously improve RA disease activity,fuction of the knee,and improve the quality of daily life.Earlier surgery could help the patients got better clinical efficacy.Part II Preliminary study on the feasibility of transplantation of regulatory B cells in treatment for knee synovitis with rheumatoid arthritisObjective:Preliminary study on the feasibility of transplantation of regulatory B cells in treatment for knee synovitis with rheumatoid arthritisMethods:In this study,8 patients suffering from knee synovitis with rheumatoid arthritis(Group I)and 8 patients suffering from OsteoArthritis(with loose body or meniscus injury,Group II)were included between July 2015 and December 2015.Group I contained 3 males and 5 females,and mean age 56 years range(46 to 68 years);5 of them suffered in left side and 3 in right side.Group ? contained 2 males and 6 females,mean age 61.9 years range(55 to 71 years);4 of them suffered in left side and 4 in right side.Both groups underwent arthroscopic surgery,and flow cytometry was used to detect the content of Breg cells(B10 cells)in blood and synovial tissue samples from two groups.Finally,8 cases of OA and 4 cases of RA were included in the study.Results:Flow cytometry analysis was performed on the samples from 8 patients,and the B10 cell with CD19+,IL10+was successfully screened out.The results showed that the percent of Breg cells in the blood or synovial tissue of RA in the total cell number(B10 frequency)was lower than that of OA,which means B10 cells had a lower expression quantity in RA.The specific results are as follows:(1)The mean percent of Breg cells in the blood of OA is 4.61±1.97,and the mean percent of RA is 3.41±1.19.(2)The mean percent of Breg cells in the synovial tissue of OA is 10.05±1.74,and the mean percent of RA is 7.83±1.67.Conclusions:The percent of Breg cells in both blood and synovial tissue of RA was lower than that of OA,that means B10 cells had a lower expression quantity in RA,suggesting that transplantation of Breg cells might contribute to delay the occurrence and development of knee synovitis with rheumatoid arthritis.This results still needs further study to confirm.