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Evaluating antirheumatic treatments using synovial biopsy: a recommendation for standardisation to be used in clinical trials
  1. Marleen G H van de Sande1,
  2. Danielle M Gerlag1,
  3. Beatrijs M Lodde1,
  4. Lisa G M van Baarsen1,
  5. Stefano Alivernini2,
  6. Veronica Codullo3,
  7. Ioana Felea4,
  8. Elsa Vieira-Sousa5,
  9. Ursula Fearon6,
  10. Richard Reece7,11,
  11. Carlomaurizio Montecucco3,
  12. Douglas J Veale6,
  13. Costantino Pitzalis8,
  14. Paul Emery7,11,
  15. Lars Klareskog9,
  16. Iain B McInnes10,
  17. Paul P Tak1
  1. 1Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  2. 2Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
  3. 3Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  4. 4Department of Rheumatology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
  5. 5Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
  6. 6Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland
  7. 7Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine
  8. 8William Harvey Research Institute, Barts and the London School of Medicine, London, UK
  9. 9Rheumatology Unit, Department of Medicine, Karolinska Institute/Karolinska University Hospital, Stockholm, Sweden
  10. 10Division of Immunology, Infection, and Inflammation, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
  11. 11NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
  1. Correspondence to Professor Paul P Tak, Division of Clinical Immunology and Rheumatology, Room F4-218, Academic Medical Center/University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands; p.p.tak{at}


Inflammation of synovium is one of the hallmarks of rheumatoid arthritis (RA). Analysis of synovial tissue has increased our understanding of RA pathogenesis, aided in identifying potential therapeutic targets and has been used in the response and mechanistic evaluation of antirheumatic treatments. In addition, studies are ongoing, aimed at the identification of diagnostic and prognostic biomarkers in the synovium. This paper outlines the currently used procedures for sampling and processing of synovial tissue, and presents a standardised recommendation to support multicentre translational research.

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  • Funding This research was supported by the European Community's FP6 funding (AutoCure) and the Dutch Arthritis Association (Reumafonds), the EULAR Synovitis Study Group and the OMERACT Special Interest Group on Synovial Analysis in Clinical Trials. SA, VC, IF and EV-S participated in the University of Glasgow/Academic Medical Center-University of Amsterdam Inflammatory Arthritis Fellowship sponsored by NovoNordisk.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.