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Synovial biopsy

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In patients with arthritis, synovial tissue is easily accessible for analysis. Blind needle biopsy is a simple and safe procedure. Arthroscopic biopsy is also safe, it allows access to most sites in the joint and it can provide adequate tissue for extensive laboratory investigations, both before and after successful therapy. Synovial tissue analysis has been successfully applied to the study of disease mechanisms and response to treatment. In addition, there may be an indication for diagnostic synovial biopsy in selected cases.

Section snippets

Blind needle biopsy

Early studies used blind needle biopsy techniques with, for instance, the Parker–Pearson needle, which is a simplified 14-gauge biopsy needle that does not require a skin incision.12 Using standard aseptic techniques, the skin and subcutaneous tissue over the biopsy area, usually the lateral aspect of the knee joint, is infiltrated to the capsule with 1% local anaesthetic after aspirating the synovial fluid. The trochar is inserted into the joint through the anaesthetised skin and the biopsy

Synovial tissue samples: how many and from which patients?

Several studies have suggested a certain degree of morphological heterogeneity in synovial samples taken from one joint.18 However, it is possible to quantify several markers of inflammation in a reliable way even when examining a limited area of tissue.23, 24, 25 For T cell infiltration and expression of activation antigens in rheumatoid arthritis (RA) synovium, a variance of less than 10% can be reached when at least six biopsy specimens are examined26, suggesting that representative data can

Processing of synovial tissue

For routine pathological examination by light microscopy, the tissue samples are fixed in 4% formalin and embedded in paraffin. This can be used for haematoxylin and eosin staining and certain immunohistochemical stainings. When gout is suspected, the biopsy samples should be conserved in absolute alcohol because the monosodium urate crystals will dissolve in most other fixatives. Unstained sections can be examined using the polarisation microscope. It is also possible to use the DeGolanthal

Differential diagnosis

In rheumatology it is usually possible to make a diagnosis on the basis of the history, clinical examination, routine laboratory tests, radiographical examination and synovial fluid analysis. When synovial fluid cannot be aspirated, or in cases of suspicion of infection in spite of negative synovial fluid culture, the examination of synovial biopsies may be of additional value.38, 39, 40 The mainstay of the diagnosis is a positive culture, but this may take days or even weeks for slow-growing

Concluding remarks

The synovial membrane is a major target tissue in RA and other arthropathies. Recent technical developments have allowed synovial biopsy samples to be obtained in a safe and generally well-tolerated way. Synovial tissue analysis can be used for diagnostic purposes in selected cases. In addition, the evaluation of inflamed synovial tissue plays an increasingly important role in pathogenetic studies as well as in the identification of novel therapeutic targets. Experimental studies evaluating the

References (89)

  • P. Szachnowski et al.

    Complications of office based arthroscopy of the knee

    J Rheumatol

    (1995)
  • R. Reece et al.

    Needle arthroscopy

    Br J Rheumatol

    (1995)
  • D. Baeten et al.

    Needle arthroscopy of the knee with synovial biopsy sampling: technical experience in 150 patients

    Clin Rheumatol

    (1999)
  • M.C. Kraan et al.

    Comparison of synovial tissues from the knee joints and the small joints of rheumatoid arthritis patients: implications for pathogenesis and evaluation of treatment

    Arthritis Rheum

    (2002)
  • R.H. Parker et al.

    A simplified synovial biopsy needle

    Arthritis Rheum

    (1963)
  • M. Soden et al.

    Immunohistological features in the synovium obtained from clinically uninvolved knee joints of patients with rheumatoid arthritis

    Br J Rheumatol

    (1989)
  • P.P. Youssef et al.

    Quantitative microscopic analysis of inflammation in rheumatoid arthritis synovial membrane samples selected at arthroscopy compared with samples obtained blindly by needle biopsy

    Arthritis Rheum

    (1998)
  • T.K. Arayssi et al.

    Evaluation of a modified needle for small joint biopsies

    J Rheumatol

    (1998)
  • W.J. Arnold

    Office-based arthroscopy

    Bull Rheum Dis

    (1992)
  • D. Kane et al.

    Survey of arthroscopy performed by rheumatologists

    Rheumatology (Oxford)

    (2002)
  • S. Lindblad et al.

    Intraarticular variation in synovitis. Local macroscopic and microscopic signs of inflammatory activity are significantly correlated

    Arthritis Rheum

    (1985)
  • M. Rooney et al.

    Analysis of the histologic variation of synovitis in rheumatoid arthritis

    Arthritis Rheum

    (1988)
  • R.J. Reece et al.

    Distinct vascular patterns of early synovitis in psoriatic, reactive, and rheumatoid arthritis

    Arthritis Rheum

    (1999)
  • D. Baeten et al.

    Comparative study of the synovial histology in rheumatoid arthritis, spondyloarthropathy, and osteoarthritis: influence of disease duration and activity

    Ann Rheum Dis

    (2000)
  • B. Bresnihan et al.

    Microscopic measurement of synovial membrane inflammation in rheumatoid arthritis: proposals for the evaluation of tissue samples by quantitative analysis

    Br J Rheumatol

    (1998)
  • P.P. Youssef et al.

    Variability in cytokine and cell adhesion molecule staining in arthroscopic synovial biopsies: quantification using color video image analysis

    J Rheumatol

    (1997)
  • M.C. Kraan et al.

    Measurement of cytokine and adhesion molecule expression in synovial tissue by digital image analysis

    Ann Rheum Dis

    (2001)
  • R.J. Dolhain et al.

    Distribution of T cells and signs of T-cell activation in the rheumatoid joint: implications for semiquantitative comparative histology

    Br J Rheumatol

    (1998)
  • D.L. Boyle et al.

    Quantitative biomarker analysis of synovial gene expression by real-time PCR

    Arthritis Res Ther

    (2003)
  • T.J. Smeets et al.

    Analysis of the cell infiltrate and expression of matrix metalloproteinases and granzyme B in paired synovial biopsy specimens from the cartilage–pannus junction in patients with RA

    Ann Rheum Dis

    (2001)
  • B. Kirkham et al.

    Intraarticular variability of synovial membrane histology, immunohistology, and cytokine mRNA expression in patients with rheumatoid arthritis

    J Rheumatol

    (1999)
  • D. Kane et al.

    Quantitation of metalloproteinase gene expression in rheumatoid and psoriatic arthritis synovial tissue distal and proximal to the cartilage–pannus junction

    J Rheumatol

    (2004)
  • P.P. Tak et al.

    Analysis of the synovial cellular infiltrate in early rheumatoid synovial tissue in relation to local disease activity

    Arthritis Rheum

    (1997)
  • A.K. Ulfgren et al.

    Interindividual and intra-articular variation of proinflammatory cytokines in patients with rheumatoid arthritis: potential implications for treatment

    Ann Rheum Dis

    (2000)
  • P.A. Klimiuk et al.

    Tissue cytokine patterns distinguish variants of rheumatoid synovitis

    Am J Pathol

    (1997)
  • T.C. van der Pouw Kraan et al.

    Rheumatoid arthritis is a heterogeneous disease: evidence for differences in the activation of the STAT-1 pathway between rheumatoid tissues

    Arthritis Rheum

    (2003)
  • Haringman JJ, Gerlag DM, Zwinderman AH et al. Synovial tissue macrophages: sensitive biomarkers for response to...
  • J. Van Holten et al.

    Treatment with recombinant interferon-beta reduces inflammation and slows cartilage destruction in the collagen-induced arthritis model of rheumatoid arthritis

    Arthritis Res Ther

    (2004)
  • C. Hitchon et al.

    Hypoxia-induced production of stromal cell-derived factor 1 (CXCL12) and vascular endothelial growth factor by synovial fibroblasts

    Arthritis Rheum

    (2002)
  • I.M. Van der Heijden et al.

    Detection of mycobacteria in joint samples from patients with arthritis using a genus-specific polymerase chain reaction and sequence analysis

    Rheumatology (Oxford)

    (1999)
  • I.M. Van der Heijden et al.

    Detection of Borrelia burgdorferi sensu stricto by reverse line blot in the joints of Dutch patients with Lyme arthritis

    Arthritis Rheum

    (1999)
  • A.G. Titov et al.

    Use of polymerase chain reaction to diagnose tuberculous arthritis from joint tissues and synovial fluid

    Arch Pathol Lab Med

    (2004)
  • I.M. van der Heijden et al.

    Detection of bacterial DNA in serial synovial samples obtained during antibiotic treatment from patients with septic arthritis

    Arthritis Rheum

    (1999)
  • J. Jalava et al.

    Bacterial PCR in the diagnosis of joint infection

    Ann Rheum Dis

    (2001)

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