Ahern, M.Campbell, D.Weedon, H.Papangelis, V.Smith, M.2009-11-302009-11-302008Annals of the Rheumatic Diseases, 2008; 67(9):1339-13420003-49671468-2060http://hdl.handle.net/2440/54120Objective: To demonstrate the efficacy of intra-articular infliximab in a patient with a persistent monarthritis who had previously had two arthroscopic synovectomies with limited success, and to determine the effect of intra-articular infliximab on synovial membrane pathology Method: Arthroscopic synovial biopsy specimens were collected before and after treatment with intra-articular infliximab. The synovial tissue was stained for a range of inflammatory cell subsets, cell adhesion molecules and cytokines using immunohistochemical techniques and quantified using digital image analysis and a semiquantitative scoring method. Results: Clinical improvement in the knee synovitis was seen after the first two intra-articular infliximab treatments, with a sustained clinical remission lasting for more than 12 months after the third treatment. Significant changes in cellular infiltration and expression of cytokines and cell adhesion molecules occurred as a result of treatment with intra-articular infliximab, with a reduction in some but not all cells in the inflammatory infiltrate, as well as a reduction in the expression of cell adhesion molecules (intercellular adhesion molecule-1 and vascular adhesion molecule-1) and production of cytokines (interleukin 1β and tumour necrosis factor α). Conclusion: Intra-articular infliximab administration is a viable treatment for a persistent monarthritis resistant to other treatment options and can successfully modulate the inflammatory milieu within the synovial membrane.enSynovial MembraneHumansSpondylarthropathiesSynovitisAntirheumatic AgentsAntibodies, MonoclonalBiopsyInjections, Intra-ArticularAdultFemaleInfliximabJournal article002008480510.1136/ard.2008.0909100002583957000252-s2.0-5024918352740517Campbell, D. [0000-0002-1572-9529]