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The term rheumatoid arthritis (RA) was first proposed by Garrod in 1859.1 By 1959, the histopathological features of synovitis, the proliferating pannus, and cartilage degradation in longstanding RA had been well described.2 Early histopathological studies were based on tissue samples obtained at surgery or at postmortem examinations. Occasionally, biopsy samples were obtained for analysis from patients with arthritis undergoing open arthrotomy.
Needle biopsy of synovium
The initial interest in developing synovial biopsy techniques was to aid the differential diagnosis of joint diseases. In 1932 Forestier described a technique for obtaining synovial tissue with a dental nerve extractor that was introduced into the joint through a large calibre needle.3 He never published his results. Early experience with needle biopsy of the synovium was described in the 1950s.4 5 It was concluded that if strict aseptic techniques were employed, the procedure was safe and practical for use in both hospital wards and outpatient clinics. However, the biopsy needles tended to cause considerable trauma to the penetrated tissues owing to their wide bore and the requirement for an incision. In 1963 Parker and Pearson developed a simplified 14-gauge biopsy needle that did not require a skin incision.6 They described their experience of 125 procedures, almost all from the suprapatellar pouch of the knee joint, of which only five failed to yield adequate tissue for analysis. No serious complications were encountered. The potential of needle biopsy as a research tool in arthritis was highlighted in 1970 by Kinsella et al in their study of synovial lining layer cells in RA,7 and in 1972 by Schumacher and Kitridou in their clinicopathological study of the early features of synovitis.8
Arthroscopic biopsy of the synovium
Arthroscopy was also initially developed as a diagnostic instrument. It was used primarily by orthopaedic surgeons.9 In the 1970s and 1980s a number …
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