Characterization of synovial tissue from arthritis patients: a proton magnetic resonance spectroscopic investigation

Rheumatol Int. 2009 Aug;29(10):1205-11. doi: 10.1007/s00296-009-0865-z. Epub 2009 Jan 28.


Hypoxia may contribute to the pathogenesis of synovitis in rheumatoid arthritis (RA). Magnetic resonance spectroscopy (MRS) is a technique that uses radiofrequency waves to generate a signal which allows a qualitative and quantitative assessment of the biochemical composition of tissue. MRS was used to evaluate RA synovial tissue for evidence of hypoxia and anaerobic metabolism. Synovial tissue samples obtained from eighteen RA patients and four osteoarthritis control patients undergoing total knee replacement were analyzed using proton MRS, processed for histopathology and scored for inflammation and vascularity. Spectra from severely and mildly inflamed tissue differed in peak intensity at regions 1.3 ppm (representing lactic acid and lipid), 3.0 ppm (representing creatine), 3.2 ppm (representing choline containing metabolites), and 3.8 ppm (representing carbohydrates, possibly glucose). With increasing inflammation, the intensities of the peak resonance at 1.3 ppm increased and that at 3.8 ppm decreased. The intensities of the 3.8 and 3.0 ppm peaks were reduced in highly vascular tissue. Specific MR spectral features reflect the anaerobic metabolism that is evident with progressively increasing degrees of RA synovial inflammation and vascularity. These features correlate partially with synovial histopathology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / metabolism*
  • Arthritis, Rheumatoid / pathology
  • Case-Control Studies
  • Choline / metabolism
  • Creatine / metabolism
  • Fucose / metabolism
  • Glucose / metabolism
  • Humans
  • In Situ Nick-End Labeling / methods
  • Inflammation / metabolism
  • Inflammation / pathology
  • Lactic Acid / metabolism
  • Lipid Metabolism
  • Magnetic Resonance Spectroscopy / methods*
  • Middle Aged
  • Synovial Membrane / metabolism*
  • Synovial Membrane / pathology


  • Fucose
  • Lactic Acid
  • Glucose
  • Creatine
  • Choline