ICAM-1, E-selectin, and TNF á expression in labial salivary glands of patients with rheumatoid vasculitis

Objective—To assess the expression of ICAM1, VCAM1, E-selectin, CD44, and TNF á in labial salivary glands of patients with rheumatoid vasculitis. Methods—Labial salivary glands from six patients with rheumatoid vasculitis before and after treatment, six aged matched rheumatoid arthritis patients without clinical evidence of rheumatoid vasculitis, 10 patients with primary Sjögren syndrome, 10 patients with rheumatoid arthritis and proven secondary Sjögren syndrome, and six controls were tested with specific antibodies. Results—ICAM1, E-selectin, and TNF á were significantly expressed in endothelial cells and perivascular cellular infiltrate only in rheumatoid vasculitis before treatment. Conclusions—The expression of ICAM1, E-selectin, and TNF á allows an assessment of the activity of the vasculitic process in rheumatoid vasculitis. Labial salivary gland biopsy findings in patients with rheumatoid arthritis and visceral vasculitis without purpura or neuropathy (that is, mesenteric, coronary, or cerebral vasculitis) would be of interest and are examples where labial salivary gland tissue is more accessible than the aVected tissue. (Ann Rheum Dis 1997;56:41–44) Diagnosis of rheumatoid vasculitis is sometimes diYcult because of the its polymorphic clinical presentation and the diYculties in interpreting the histological findings. Rheumatoid vasculitis is commonly described as a panarteritis involving blood vessels of all sizes, particularly small arteries such as the digital arteries. Various tissues have been biopsied to look for pathological evidence of vasculitis in patients with rheumatoid arthritis. 4 In a previous study, we found pathological features of perivascular inflammatory infiltrate with microvascular damage in labial salivary gland tissue in 90% of patients with rheumatoid vasculitis compared with only 20% in a control group of rheumatoid arthritis patients. There is increasing evidence for the importance of endothelial and leucocyte adhesion molecules in the development of inflammatory injury. Cellular adhesion molecules and TNF á have been implicated in the pathogenesis of rheumatoid arthritis, 7 and adhesion molecules might play a role in the pathogenesis of vasculitis by enhancing lymphocyte-endothelial cell molecular interactions and promoting damage to the endothelium. To determine whether areas with microvascular damage in labial salivary glands from patients with rheumatoid vasculitis show upregulation of cell adhesion molecules and TNF á, we have examined the expression of intercellular adhesion molecule 1 (ICAM1), vascular cell adhesion molecule 1 (VCAM1), endothelial leucocyte adhesion molecule-1 (E-selectin), CD44, and TNF á in labial salivary gland biopsy specimen from patients with rheumatoid vasculitis before and after successful treatment. Methods Patients were consecutively recruited in a one year prospective study from one department of rheumatology (table 1). Patients with rheumatoid arthritis fulfilled the criteria proposed by the American Rheumatism Association. Six groups were formed. Group I was composed of six patients with proven evidence of rheumatoid vasculitis, based on the criteria proposed in 1984 by Scott and Bacon. Clinical data on these six patients are summarised in table 2. Group II was composed of the same six patients reviewed after a mean period of nine months after treatment (all the patients with rheumatoid vasculitis were treated with intermittent pulses of intravenous cyclophosphamide plus methylprednisolone). A favourable clinical outcome was observed for all these patients. With a mean follow up of one year, none of the patients died. Group III comprised six patients with rheumatoid arthritis without clinical evidence of vasculitis, matched for age and gender. These patients were admitted to hospital because of progressive disease and the need to adjust treatment. Group IV comprised 10 patients with primary Sjögren syndrome without clinical signs of vasculitis or cryoglobulinaemia. Group V comprised 10 patients with rheumatoid arthritis without signs of rheumatoid vasculitis and with proven secondary Sjögren syndrome, defined according to Annals of the Rheumatic Diseases 1997;56:41–44 41 Hôpital Calmette, Lille, France: Department of Rheumatology R M Flipo T Cardon M Vandecandelaere B Duquesnoy Department of Pathology C M C Copin A Janin Correspondence to: Pr René-Marc Flipo, Department of Rheumatology, Hôpital Roger Salengro, CHRU, 59037 Lille cedex, France. Accepted for publication 11 October 1996 group.bmj.com on April 3, 2017 Published by http://ard.bmj.com/ Downloaded from