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De Stefano L, Bugatti S, Mazzucchelli I, Rossi S, Xoxi B, Bozzalla Cassione E, Luvaro T, Montecucco C, Manzo A. Synovial and serum B cell signature of autoantibody-negative rheumatoid arthritis vs autoantibody-positive rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford) 2024; 63:1322-1331. [PMID: 37481716 DOI: 10.1093/rheumatology/kead378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVES Autoantibody-negative RA differs from autoantibody-positive RA in several clinical aspects, possibly underpinned by pathogenetic differences. At present, the role of adaptive immune responses in autoantibody-negative RA remains unclear. Here, we investigated the synovial and serum immunophenotype indicative of B lymphocyte involvement across the spectrum of autoantibody-positive and -negative chronic arthritides. METHODS Ultrasound-guided synovial biopsies were retrieved from 131 patients: 43 autoantibody-positive RA, 35 autoantibody-negative RA, 25 polyarticular PsA and 28 oligoarticular PsA. Samples were analysed for the degree of histological inflammation, B lymphocyte infiltration and the distribution of different pathotypes (lympho-myeloid, myeloid, pauci-immune). Serum levels of the B cell chemoattractant CXCL13 were compared among groups. RESULTS Synovitis scores and CD68+ sublining macrophage infiltration were comparable irrespective of clinical diagnosis and disease subtype. In contrast, the degree of B lymphocyte infiltration and the frequency of lympho-myeloid synovitis in autoantibody-negative RA were lower than those of autoantibody-positive RA (mean [s.d.] 1.8 [1] vs 2.4 [0.6], P = 0.03, and 38.2% vs 62.9%, P = 0.07, respectively), and similar to polyarticular PsA. Oligoarticular PsA had the lowest B cell scores. Serum CXCL13 was associated with lympho-myeloid synovitis and followed a similar gradient, with the highest levels in autoantibody-positive RA, intermediate and comparable levels in autoantibody-negative RA and polyarticular PsA, and low levels in oligoarticular PsA. CONCLUSIONS The synovial and serum immunophenotype indicative of B lymphocyte involvement in autoantibody-negative RA differs from that of autoantibody-positive RA and more closely resembles that observed in polyarticular PsA. The pathobiological stratification of chronic inflammatory arthritides beyond clinical diagnosis may fuel personalized treatment strategies.
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Affiliation(s)
- Ludovico De Stefano
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Serena Bugatti
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Iolanda Mazzucchelli
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Silvia Rossi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Blerina Xoxi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Bozzalla Cassione
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Terenzj Luvaro
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Manzo
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Fuentes-Braesch M, Tuijthof GJM, Emans PJ, Emanuel KS. The preferred technique for knee synovium biopsy and synovial fluid arthrocentesis. Rheumatol Int 2023; 43:1767-1779. [PMID: 36513849 DOI: 10.1007/s00296-022-05256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
For knee osteoarthritis and related conditions, analysis of biomarkers hold promise to improve early diagnosis and/or offer patient-specific treatment. To compare biomarker analyses, reliable, high-quality biopsies are needed. The aim of this work is to summarize the literature on the current best practices of biopsy of the synovium and synovial fluid arthrocentesis. Therefore, PubMed, Embase and Web of Science were systematically searched for articles that applied, demonstrated, or evaluated synovial biopsies or arthrocentesis. Expert recommendations and applications were summarized, and evidence for superiority of techniques was evaluated. Thirty-one studies were identified for inclusion. For arthrocentesis, the superolateral approach in a supine position, with a 0°-30° knee flexion was generally recommended. 18-gage needles, mechanical compression and ultrasound-guidance were found to give superior results. For blind and image-guided synovial biopsy techniques, superolateral and infrapatellar approaches were recommended. Single-handed tools were preconized, including Parker-Pearson needles and forceps. Sample quantity ranged approximately from 2 to 20. Suggestions were compiled for arthrocentesis regarding approach portal and patient position. Further evidence regarding needle size, ultrasound-guidance and mechanical compression were found. More comparative studies are needed before evidence-based protocols can be developed.
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Affiliation(s)
- Marie Fuentes-Braesch
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Orthopedic Surgery, Maastricht UMC+, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Pieter J Emans
- Department of Orthopedic Surgery, Maastricht UMC+, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery, Maastricht UMC+, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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De Stefano L, Bugatti S, Piccin V, D'Ambrosio G, Luvaro T, Xoxi B, Montecucco C, Manzo A. The access route through the anatomical snuffbox in ultrasound-guided synovial biopsy of the wrist allows for a safe and effective collection of tissue samples in inflammatory arthritis. Arthritis Res Ther 2023; 25:119. [PMID: 37422683 PMCID: PMC10329327 DOI: 10.1186/s13075-023-03101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND A proof-of-concept study to evaluate the feasibility and safety of minimally invasive ultrasound (US)-guided synovial biopsy of the radiocarpal (RC) joint using the anatomical snuffbox as an access route. METHODS Twenty consecutive patients with active chronic arthritis of the wrist underwent minimally invasive US-guided synovial biopsy of the RC joint using the anatomical snuffbox as the access route. Samples were retrieved from 3 predetermined biopsy target sites of the RC synovia (proximal, vault, and distal site), aiming for a minimum of 12 samples. The procedure's feasibility was evaluated based on the number and histological quality of retrieved tissue fragments tested on pre-defined histometric parameters. The safety and tolerability of the procedure were assessed through 1-week and 1-month follow-up clinical evaluations. RESULTS A median number of 17 fragments (≥ 1 mm diameter size at macroscopic evaluation) per procedure was processed for histopathology (range 9-24) and dedicated to the study. At the histopathologic evaluation, a gradable tissue (visible lining layer and ≥ 4 fragments with IST) was recognized in 19/20 biopsies (95%), and all pre-defined histometric parameters were judged applicable and successfully measured in 19/19 gradable biopsies. All three biopsy target sites showed sampling accessibility. The entire procedure was generally well tolerated. At the 1-month follow-up, no patients showed infectious complications. CONCLUSIONS The access route through the anatomical snuff box in US-guided synovial biopsies of the RC joint allows for a safe and targeted collection of adequate tissue samples. This modification of the traditional access route may allow easier, repeatable, and safer sampling of anatomically distinct areas of the wrist in the course of arthritis.
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Affiliation(s)
- Ludovico De Stefano
- Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy.
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Serena Bugatti
- Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Veronica Piccin
- Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | | | - Terenzj Luvaro
- Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy
| | - Blerina Xoxi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Antonio Manzo
- Department of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
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Iaquinta FS, Rivellese F, Pitzalis C. Synovial biopsies for molecular definition of rheumatoid arthritis and treatment response phenotyping: where can we improve? Expert Rev Mol Diagn 2023; 23:1071-1076. [PMID: 37979075 DOI: 10.1080/14737159.2023.2284774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The extensive knowledge gained in the cellular and molecular mechanisms underlying Rheumatoid Arthritis (RA) pathogenesis has led to therapeutic advances. However, up to 10-20% of patients fail to respond to multiple therapeutic agents being classified as multi-drugresistant. A key challenge moving forward will be the implementation of synovial biopsies in clinical practice to facilitate the shift from the current trial-and-error strategy toward new forms of clinical trials. Biomarker-driven trials have the potential to improve drug selection and patient stratification, reduce economic costs and unnecessary drug-related toxicity. AREAS COVERED This special report explores the clinical and research applications of synovial biopsy, the advancement in the molecular pathobiology of RA to better understand disease pathogenesis and treatment response, and the way forward for the paradigm shift needed. EXPERT OPINION In the current era of highly targeted biologic drugs which have dramatically transformed the outlook of RA patients, the use of synovial biopsy represents a valuable practical tool to dissect disease pathogenesis and, consequently, treatment response. In the near future, it is hoped that technological advances will allow for speeding up synovial molecular analysis and that the design of new biomarker-driven trials will enable the allocation of patients to more effective treatment.
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Affiliation(s)
- Francesco Salvatore Iaquinta
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
| | - Felice Rivellese
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts NIHR BRC & NHS Trust & National Institute for Health and Care Research (NIHR) Barts Biomedical Research Centre (BRC), London, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Ben-Artzi A, Horowitz DL, Mandelin AM, Tabechian D. Best practices for ultrasound-guided synovial biopsy in the United States. Best Pract Res Clin Rheumatol 2023; 37:101834. [PMID: 37263809 DOI: 10.1016/j.berh.2023.101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023]
Abstract
The target organ in many forms of inflammatory arthritis is the synovium. However, synovial tissue has historically been perceived as either difficult to obtain or of little practical value. Ultrasound-guided synovial biopsy [UGSB] is a safe and well-tolerated bedside procedure that is established in Europe and rapidly growing in popularity in the United States. The technique can be mastered by rheumatologists who are already experienced in ultrasound-guided procedures such as joint aspirations. The USGB procedure allows the proceduralist to access small, medium, and large joints and is inexpensive and less invasive compared to surgical alternatives. The relative ease of obtaining this tissue, along with recent research suggesting that synovium may have more clinical and investigational utility than previously thought, has led clinicians and researchers to a new appreciation of the role of synovial biopsy in both the clinical and research setting. In this manuscript, the authors present recommendations on best practices for ultrasound-guided synovial biopsy in the United States, based on our initial training with well-established experts overseas and our own subsequent collective experience in performing numerous synovial biopsies in the United States over the past 7 years for both clinical and research indications. We envision a future where UGSB is more frequently incorporated in the standard diagnostic workup of arthritis and drives novel research initiatives.
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Affiliation(s)
- Ami Ben-Artzi
- Cedars Sinai Medical Center Staff Member, Los Angeles, CA, USA; Scripps Memorial Hospital Staff Member, San Diego, CA, USA.
| | - Diane L Horowitz
- Zucker School of Medicine at Hofstra/Northwell, Department of Medicine, Division of Rheumatology, Great Neck, NY, USA
| | - Arthur M Mandelin
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of Rheumatology, Chicago, IL, USA
| | - Darren Tabechian
- Department of Medicine, Division of Allergy Immunology and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Soroosh SG, Ghatfan A, Farbod A, Meftah E. Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis. BMC Musculoskelet Disord 2023; 24:23. [PMID: 36631793 PMCID: PMC9832794 DOI: 10.1186/s12891-023-06138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Undifferentiated arthritis is a condition in which the problem cannot be classified into any definite diagnosis category. Various methods have been suggested to clarify the definite diagnosis in this class. The synovial biopsy is suggested as the last diagnostic approach to determine the precise histopathological diagnosis. In this study, we aimed to evaluate the efficacy of synovial biopsy for establishing a definite diagnosis in patients with undifferentiated chronic knee monoarthritis. METHODS The present retrospective case series was conducted in 2005 in the rheumatology research center of Shariati hospital and the 501 hospital in Tehran, Iran. The study included the synovial biopsy of patients with chronic knee monoarthritis who did not have a definite diagnosis after all the diagnostic steps before the synovial biopsy. Pathology slides of the patients' synovial biopsy were reevaluated with a senior expert pathologist. RESULTS Eighty patients with a mean age of 37.6 ± 17.32 years (range: 6-68) were included, of whom 50% were female. The gap time between the onset of knee monoarthritis and the decision-making for synovial biopsy was 14.34 ± 19.61 months. Histopathologic evaluations revealed non-specific synovitis in 65% of the patients and a definite diagnosis in 35%. The most common definite diagnosis was rheumatoid arthritis (9%), followed by septic arthritis (5%). The most common pathologic findings were endothelial proliferation (89%) and synovial proliferation (88%), and the most common infiltrating cell was lymphocyte (54%). Patients with non-specific synovitis were more likely to have neovascularization, cellular infiltration (p-value < 0.001), synovial proliferation, endothelial proliferation (p-value = 0.001), pannus formation (p-value = 0.009), and fibrosis (p-value = 0.022) compared to the patients with a definite pathologic diagnosis. However, age, gender, and the gap time between disease symptoms to synovial biopsy were not significantly different between the different groups of diagnosis (p-value > 0.05). CONCLUSION Non-specific synovitis remains the most common histopathologic finding, highlighting the importance of physician expert opinion for most of the patients with undifferentiated chronic knee monoarthritis. Studies with larger samples and immunohistochemistry analyses are needed to clarify this uncategorized entity further.
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Affiliation(s)
- Soosan G Soroosh
- grid.411259.a0000 0000 9286 0323Rheumatology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Ali Ghatfan
- grid.411259.a0000 0000 9286 0323501 Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Abolfazl Farbod
- grid.411705.60000 0001 0166 0922Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Meftah
- grid.411705.60000 0001 0166 0922Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Impact of the biopsy forceps size on histological analysis and performances of the histological scoring systems. Sci Rep 2022; 12:5692. [PMID: 35383240 PMCID: PMC8983678 DOI: 10.1038/s41598-022-09704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
To improve the reliability of the quantitative scorings of the synovial biopsies, we evaluate whether diameter of arthroscopic forceps influences histological quality of synovial tissue and/or histological scores and we compare the intra- and inter-observer performances of the main histological scoring systems. Synovial biopsies were retrieved in the same part of the joint using 1, 2 and 4 mm diameters grasping forceps. After standard staining and immunohistochemistry with anti-CD68 antibody, slides were scored blindly by 2 independent experienced operators for tissue quality and with Krenn score, de Bois-Tak score and CD68 semi-quantitative score. Four samples did not pass quality control. No difference other than a higher number of vessels in the 4 mm versus 2 mm forceps (p = 0.01) was found among the 3 groups. CD68 score was significantly higher in the 2 versus 4 mm forceps (p = 0.009). So we concluded that only vessels quantification and CD68 semi-quantitative score seemed affected by the forceps size. The intra-reader agreement was variable across observers and features: 0.78 (0.66–0.87) for the Krenn scoring system, 0.89 (0.78–0.97) for the de Bois-Tak score and 0.93 (0.81–1.00) for the CD68 score. Interobserver reliabilities of Krenn score, de Bois-Tak score and CD68 scores were satisfactory: 0.95 (0.92–0.99) for Krenn, 0.98 (0.96–0.99) for de Bois-Tak and 0.80 (0.71–0.89) for CD68.
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Najm A, Costantino F, Alivernini S, Alunno A, Bianchi E, Bignall J, Boyce B, Canete JD, Carubbi F, Durez P, Fonseca JE, Just SA, Largo R, Manzo A, Maybury M, Naredo E, Orr C, Pitzalis C, Rivellese F, Romão VC, van Rompay J, Tas SW, Veale DJ, D'Agostino MA, Filer A. EULAR points to consider for minimal reporting requirements in synovial tissue research in rheumatology. Ann Rheum Dis 2022; 81:1640-1646. [PMID: 35210263 DOI: 10.1136/annrheumdis-2021-221875] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Synovial tissue research has become widely developed in several rheumatology centres, however, large discrepancies exist in the way synovial tissue is handled and, more specifically, how data pertaining to biopsy procedure, quality check and experimental results are reported in the literature. This heterogeneity hampers the progress of research in this rapidly expanding field. In that context, under the umbrella of European Alliance of Associations for Rheumatology, we aimed at proposing points to consider (PtC) for minimal reporting requirements in synovial tissue research. METHODS Twenty-five members from 10 countries across Europe and USA met virtually to define the key areas needing evaluation and formulating the research questions to inform a systematic literature review (SLR). The results were presented during a second virtual meeting where PtC were formulated and agreed. RESULTS Study design, biopsy procedures, tissue handling, tissue quality control and tissue outcomes (imaging, DNA/RNA analysis and disaggregation) were identified as important aspects for the quality of synovial tissue research. The SLR interrogated four databases, retrieved 7654 abstracts and included 26 manuscripts. Three OPs and nine PtC were formulated covering the following areas: description of biopsy procedure, overarching clinical design, patient characteristics, tissue handling and processing, quality control, histopathology, transcriptomic analyses and single-cell technologies. CONCLUSIONS These PtC provide guidance on how research involving synovial tissue should be reported to ensure a better evaluation of results by readers, reviewers and the broader scientific community. We anticipate that these PtC will enable the field to progress in a robust and transparent manner over the coming years.
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Affiliation(s)
- Aurélie Najm
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Félicie Costantino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et Inflammation, Laboratory of Excellence Inflamex, Montigny-Le-Bretonneux, France.,Rheumatology Department, AP-HP, Boulogne-billancourt, Paris, France
| | - Stefano Alivernini
- UOC di Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Elettra Bianchi
- Department of Pathology, Department of Anatomical Pathology, Central University Hospital of Liege, Liege, Belgium
| | - Jacqueline Bignall
- Rheumatology Patient Group, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Brendan Boyce
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Juan D Canete
- Arthritis Unit, Rheumatology Dpt, IDIBAPS, Barcelona, Spain.,Joint and Bone Research Unit. Rheumatology Dept, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Medicine, San Salvatore Hospital, L'Aquila, Italy
| | - Patrick Durez
- Pôle de Recherche en Rhumatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain Secteur des sciences de la santé, Bruxelles, Belgium.,Pôle de Recherche en Rhumatologie, Institut de Recherche Expérimentale et Clinique, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - João Eurico Fonseca
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Instituto de Medicina Molecular, Lisboa, Portugal
| | - Søren Andreas Just
- Department of Rheumatology, Bone and Joint Research Unit, Odense Universitetshospital, Odense, Denmark
| | - Raquel Largo
- Joint and Bone Research Unit. Rheumatology Dept, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
| | - Antonio Manzo
- Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mark Maybury
- Rheumatology Research Group and Research into Inflammatory Arthritis Centre Versus Arthritis, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Center, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Esperanza Naredo
- Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Rheumatology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carl Orr
- Centre for Arthritis and Rheumatic Disease, University College Dublin, Dublin, Ireland.,The Conway Institute, St Vincent's University Hospital, Dublin, Ireland
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry William Harvey Research Institute, London, UK
| | - Felice Rivellese
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry William Harvey Research Institute, London, UK
| | - Vasco C Romão
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Instituto de Medicina Molecular, Lisboa, Portugal
| | - Jef van Rompay
- Patient Research Partners, Antwerp Province, Antwerpen, Belgium
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Douglas J Veale
- Centre for Arthritis and Rheumatic Disease, University College Dublin, Dublin, Ireland.,The Conway Institute, St Vincent's University Hospital, Dublin, Ireland
| | - Maria-Antonietta D'Agostino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et Inflammation, Laboratory of Excellence Inflamex, Montigny-Le-Bretonneux, France.,UOC di Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrew Filer
- Rheumatology Research Group and Research into Inflammatory Arthritis Centre Versus Arthritis, Institute of Inflammation and Ageing, NIHR Birmingham Biomedical Research Center, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Najm A, Costantino F, Weill C, Filer A, D'Agostino MA. Impact of synovial biopsy procedures and disease-specific aspects on synovial tissue outcome: a systematic literature review informing the EULAR points to consider for the minimal reporting requirements in synovial tissue research in rheumatology. RMD Open 2022; 8:rmdopen-2021-002116. [PMID: 35177556 PMCID: PMC8860072 DOI: 10.1136/rmdopen-2021-002116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of this work was to summarise the literature evaluating the impact of biopsy procedures, tissue handling, tissue quality and disease-specific aspects including joint biopsied and disease stage, on synovial tissue outcome. METHODS Two reviewers independently identified eligible studies according to the Patients, Intervention, Comparator and Outcome framework obtained for five research questions formulated during the first EULAR task force meeting to produce points to consider (PtC) for minimal reporting requirements in synovial tissue studies. The databases explored were Medline, Embase, CENTRAL and Cinhal. The risk of bias of each study was evaluated using an adapted version of the Joanna Briggs Institute checklist for analytical cross-sectional studies. RESULTS Of the 7654 records yielded, 75 full texts were assessed, leading to the inclusion of 26 manuscripts in the systematic literature review (SLR). Two papers assessed the impact of biopsy procedures on the quality and quantity of tissue retrieved alongside patient tolerability; six papers focused on synovial tissue variability. Four papers studied the impact of sample handling or randomisation and 14 assessed the impact of disease stage and state, namely early or established active rheumatoid arthritis and remission on histopathological and transcriptomic results. CONCLUSIONS This SLR informs the EULAR PtC for minimal reporting requirements in synovial tissue research in rheumatology. Characteristics related to the study design, population, sample handling, randomisation and analysis can affect the final synovial tissue outcome in the studies reviewed. Thus, accurate reporting of these factors is required in order to ensure the scientific validity of manuscripts describing synovial tissue outcomes.
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Affiliation(s)
- Aurélie Najm
- Musculoskeletal Research Group, Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Félicie Costantino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of excellence Inflamex, Paris, Île-de-France, France.,Rheumatology Department, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Catherine Weill
- Medicine, University of Paris Health Interuniversity Library, Paris, Île-de-France, France
| | - Andrew Filer
- Rheumatology Research Group and Research into Inflammatory Arthritis Centre Versus Arthritis, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Maria Antonieta D'Agostino
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et inflammation, Laboratory of excellence Inflamex, Paris, Île-de-France, France.,Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
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11
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Bosch P, Carubbi F, Scirè CA, Baraliakos X, Falzon L, Dejaco C, Machado PM. Value of imaging to guide interventional procedures in rheumatic and musculoskeletal diseases: a systematic literature review informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2021-001864. [PMID: 34810228 PMCID: PMC8609947 DOI: 10.1136/rmdopen-2021-001864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To summarise current data on the value of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal disease (RMDs) informing an European Alliance of Associations for Rheumatology taskforce. METHODS A systematic literature review was conducted to retrieve prospective and retrospective studies published in English and comparing different (imaging) techniques, different settings and procedural protocols to guide interventions in patients with RMDs. MEDLINE, EMBASE, the Cochrane Library and Epistemonikos databases were searched through October 2021. Risk of bias (RoB) was assessed using the Cochrane RoB tool for randomised trials V.2 (ROB2), the RoB tool for Non-Randomised Studies of Interventions and the appraisal tool for cross-sectional studies. RESULTS Sixty-six studies were included (most with moderate/high RoB); 49 were randomised controlled trials, three prospective cohort studies and 14 retrospective studies. Fifty-one studies compared either one imaging technique with another imaging technique, or with palpation-guided interventions. Ultrasound (US) was most frequently studied (49/51), followed by fluoroscopy (10/51). Higher accuracy was found for US or fluoroscopy compared with palpation-guided interventions. Studies comparing different imaging techniques (12/51) did not endorse one specific method. Different settings/equipment for imaging-guided procedures (eg, automatic vs manual syringes) were investigated in three studies, reporting heterogeneous results. Fifteen studies compared different imaging-guided procedures (eg, intra-articular vs periarticular injections). CONCLUSION Higher accuracy of needle positioning at joints and periarticular structures was seen in most studies when using imaging (especially US) guidance as compared with palpation-guided interventions with the limitation of heterogeneity of data and considerable RoB.
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Affiliation(s)
- Philipp Bosch
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | | | | | | | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria .,Rheumatology Service, Hospital of Bruneck, Bruneck, Italy
| | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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12
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Ingegnoli F, Coletto LA, Scotti I, Compagnoni R, Randelli PS, Caporali R. The Crucial Questions on Synovial Biopsy: When, Why, Who, What, Where, and How? Front Med (Lausanne) 2021; 8:705382. [PMID: 34422862 PMCID: PMC8377390 DOI: 10.3389/fmed.2021.705382] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
In the majority of joint diseases, changes in the organization of the synovial architecture appear early. Synovial tissue analysis might provide useful information for the diagnosis, especially in atypical and rare joint disorders, and might have a value in case of undifferentiated inflammatory arthritis, by improving disease classification. After patient selection, it is crucial to address the dialogue between the clinician and the pathologist for adequately handling the sample, allowing identifying histological patterns depending on the clinical suspicion. Moreover, synovial tissue analysis gives insight into disease progression helping patient stratification, by working as an actionable and mechanistic biomarker. Finally, it contributes to an understanding of joint disease pathogenesis holding promise for identifying new synovial biomarkers and developing new therapeutic strategies. All of the indications mentioned above are not so far from being investigated in everyday clinical practice in tertiary referral hospitals, thanks to the great feasibility and safety of old and more recent techniques such as ultrasound-guided needle biopsy and needle arthroscopy. Thus, even in rheumatology clinical practice, pathobiology might be a key component in the management and treatment decision-making process. This review aims to examine some essential and crucial points regarding why, when, where, and how to perform a synovial biopsy in clinical practice and research settings and what information you might expect after a proper patient selection.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Isabella Scotti
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Riccardo Compagnoni
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Pietro Simone Randelli
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
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13
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Ike RW, Kalunian KC. Will rheumatologists ever pick up the arthroscope again? Int J Rheum Dis 2021; 24:1235-1246. [PMID: 34323382 DOI: 10.1111/1756-185x.14184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/26/2021] [Accepted: 07/12/2021] [Indexed: 02/04/2023]
Abstract
Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. The post-War father of modern arthroscopy, Watanabe, found rheumatologists among his early students, who took back the technique to their home countries, teaching orthopedists and rheumatologists alike. Rheumatologists described and analyzed the intra-articular features of their common diseases in the '60s and '70s. A groundswell of interest from academic rheumatologists in adapting arthroscopy grew considerably in the '90s with development of "needle scopes" that could be used in an office setting. Rheumatologists helped conduct the very trials the findings of which reduced demand for their arthroscopic services by questioning the efficacy of arthroscopic debridement in osteoarthritis (OA) and also developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is now imaged mainly by magnetic resonance imaging, some OA features - such as a high prevalence of visible calcinosis - beg further arthroscopy-directed investigation. A new generation of "needle scopes" with far superior optics awaits future investigators, should they develop interest.
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Affiliation(s)
- Robert W Ike
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Kenneth C Kalunian
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California at San Diego, San Diego, CA, USA
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14
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Saraiva F. Ultrasound-Guided Synovial Biopsy: A Review. Front Med (Lausanne) 2021; 8:632224. [PMID: 33968950 PMCID: PMC8100029 DOI: 10.3389/fmed.2021.632224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Ultrasound-guided synovial biopsy is a safe, well-tolerated, and effective method to collect good-quality synovial tissue from all types of joints for clinical and research purposes. Although synovial biopsy cannot be used to distinguish between types of inflammatory rheumatic disease, analysis of synovial tissue has led to remarkable advances in the understanding of the pathobiology of rheumatoid arthritis and other inflammatory rheumatic diseases. Synovitis is the hallmark of these diseases; hence, accessing the core of the pathological process, synovial tissue, provides an opportunity to gather information with potential diagnostic and prognostic utility.
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Affiliation(s)
- Fernando Saraiva
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Lisbon, Portugal.,Unidade de Investigação em Reumatologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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15
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Johnsson H, Najm A. Synovial biopsies in clinical practice and research: current developments and perspectives. Clin Rheumatol 2020; 40:2593-2600. [PMID: 33274415 PMCID: PMC8189968 DOI: 10.1007/s10067-020-05512-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/31/2020] [Accepted: 11/15/2020] [Indexed: 12/25/2022]
Abstract
Synovial biopsy techniques have developed and widely expanded over the past few years, in particular due to the development of ultrasound-guided procedures. This article reviews the different techniques, clinical applications, and the latest advances in translational research as well as current challenges and perspectives. The first part focuses on different techniques available for biopsy, along with their feasibility, success rate, tolerance, and training requirements. In the second part, clinical applications are described. Data on diagnostic performances are reported, especially regarding septic arthritis. Translational research applications are described and explained in the final part, from the early histological studies and the first description of pathotype to more recent technologies involving -omics. Latest developments involving single-cell RNA sequence analysis have allowed the discovery of new cell subpopulations with remarkable roles in RA pathophysiology. These studies pave the ground for the discovery of new therapeutic targets and the implementation of personalized therapy in RA.Key Point •This review provides an overview of synovial biopsy techinques and applications especially in clinical and translational research. |
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Affiliation(s)
- Hanna Johnsson
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow and Rheumatology Department Greater Glasgow and Clyde, Glasgow, UK
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow and Rheumatology Department Greater Glasgow and Clyde, Glasgow, UK.
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16
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Ike RW, Arnold WJ, Kalunian KC. Arthroscopy in rheumatology: where have we been? Where might we go? Rheumatology (Oxford) 2020; 60:518-528. [DOI: 10.1093/rheumatology/keaa560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with ‘needle scopes’ used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features—such as calcinosis—beg further arthroscopic investigation. A new generation of ‘needle scopes’ with far superior optics awaits future investigators.
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Affiliation(s)
- Robert W Ike
- Division of Rheumatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - William J Arnold
- Orthopaedics and Rheumatology of the North Shore, Wilmette, IL, USA
| | - Kenneth C Kalunian
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California at San Diego, San Diego, CA, USA
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17
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Romão VC, Polido-Pereira J, Barros R, Luís R, Vidal B, Vieira-Sousa E, Vitorino E, Humby F, Kelly S, Pitzalis C, Saraiva F, Fonseca JE. Efficacy, Safety, and Sample Quality of Ultrasound-Guided Synovial Needle Biopsy in Clinical Practice and Research: A Prospective Observational Study. Arthritis Care Res (Hoboken) 2020; 72:1497-1505. [PMID: 31421034 DOI: 10.1002/acr.24050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To study the efficacy, tolerability, safety, and sampling variation of ultrasound (US)-guided synovial biopsies performed in clinical practice and research. METHODS We included all patients who had a US-guided synovial needle biopsy from November 2013 to January 2018. Patients were evaluated for procedure safety and tolerability. Usefulness of synovial biopsy was considered based on contribution for achieving the proposed aims. We analyzed samples for presence and quality of synovial tissue, synovitis score/grade, and pathotype. Variation across patients, samples, section levels, and sampling order was assessed. RESULTS A total of 64 US-guided synovial biopsies were performed (n = 52 in clinical practice, n = 12 in research). Patient tolerability (70% no/mild discomfort) was remarkably high. There was no significant aggravation of symptoms or US synovitis in the biopsied joint. Procedures were overall safe, with few minor, 2 moderate, and no major adverse events. Usefulness of US-guided synovial biopsies was high, both in clinical practice (37% direct diagnostic impact, 100% positive/95% negative predictive values for infection) and in research (92% success). Synovial tissue was retrieved in 88% of biopsies, with a median of 75% gradable samples. There was significant variation in sample quality and synovitis features across patients and samples, but not between different section levels. Samples collected later in the procedure had a lower frequency of synovial tissue and were poorly concordant in pathotype with those collected earlier. CONCLUSION US-guided synovial needle biopsy is an effective, safe, and well-tolerated means to collect good quality synovial tissue for clinical and research purposes. Samples collected for different aims should be retrieved in parallel, rather than sequentially.
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Affiliation(s)
- Vasco C Romão
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Joaquim Polido-Pereira
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Rita Barros
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Rita Luís
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, and Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Bruno Vidal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Emília Vitorino
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, London, United Kingdom
| | - Frances Humby
- William Harvey Research Institute, Barts and the London School of Medicine , London, United Kingdom
| | - Stephen Kelly
- Mile End Hospital, Barts Health NHS Trust, London, UK
| | - Costantino Pitzalis
- William Harvey Research Institute, Barts and the London School of Medicine , London, United Kingdom
| | - Fernando Saraiva
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, London, United Kingdom
| | - João Eurico Fonseca
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
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18
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Kondo Y, Suzuki K, Inoue Y, Sakata K, Takahashi C, Kaneko Y, Takeuchi T. Safety and tolerability of ultrasound-guided synovial needle biopsy in Japanese arthritis patients. Mod Rheumatol 2020; 31:960-965. [PMID: 33155872 DOI: 10.1080/14397595.2020.1847754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We sought to clarify the safety and tolerability of ultrasound (US)-guided synovial needle biopsy in hand and knee joints in Japanese arthritis patients. METHODS A total of nine consecutive arthritis patients were recruited and scheduled for US-guided synovial needle biopsies. Patients completed a safety questionnaire and patient-reported outcomes (PRO) data of joint pain, stiffness, and swelling pre- and postbiopsy. We also recorded patients' characteristics and willingness to undergo a second biopsy by the same technique. All synovial needle biopsy samples were assessed with pathological and microbial examination to verify whether clinical evaluation was possible. RESULTS Five and 4 patients underwent US-guided biopsy from hand and knee joints, respectively. PRO data showed no significant differences in pain, swelling, or stiffness levels before and after biopsy, with a mean 11.8 samples collected per procedure. No significant complications, including joint infection, bleeding, or vasovagal signs, were reported. Histologically adequate synovial tissue was identified in 83 (78%) samples. We were able to submit the biopsy samples to pathological and bacterial analysis to exclude septic arthritis. CONCLUSION We demonstrated that a minimally invasive US-guided needle biopsy is a safe and well-tolerated procedure and the synovial tissue collected was of adequate quality for pathological analysis.
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Affiliation(s)
- Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yumiko Inoue
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Komei Sakata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Chihiro Takahashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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19
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Penkava F, Velasco-Herrera MDC, Young MD, Yager N, Nwosu LN, Pratt AG, Lara AL, Guzzo C, Maroof A, Mamanova L, Cole S, Efremova M, Simone D, Filer A, Brown CC, Croxford AL, Isaacs JD, Teichmann S, Bowness P, Behjati S, Hussein Al-Mossawi M. Single-cell sequencing reveals clonal expansions of pro-inflammatory synovial CD8 T cells expressing tissue-homing receptors in psoriatic arthritis. Nat Commun 2020; 11:4767. [PMID: 32958743 PMCID: PMC7505844 DOI: 10.1038/s41467-020-18513-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/27/2020] [Indexed: 11/08/2022] Open
Abstract
Psoriatic arthritis (PsA) is a debilitating immune-mediated inflammatory arthritis of unknown pathogenesis commonly affecting patients with skin psoriasis. Here we use complementary single-cell approaches to study leukocytes from PsA joints. Mass cytometry demonstrates a 3-fold expansion of memory CD8 T cells in the joints of PsA patients compared to peripheral blood. Meanwhile, droplet-based and plate-based single-cell RNA sequencing of paired T cell receptor alpha and beta chain sequences show pronounced CD8 T cell clonal expansions within the joints. Transcriptome analyses find these expanded synovial CD8 T cells to express cycling, activation, tissue-homing and tissue residency markers. T cell receptor sequence comparison between patients identifies clonal convergence. Finally, chemokine receptor CXCR3 is upregulated in the expanded synovial CD8 T cells, while two CXCR3 ligands, CXCL9 and CXCL10, are elevated in PsA synovial fluid. Our data thus provide a quantitative molecular insight into the cellular immune landscape of psoriatic arthritis.
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MESH Headings
- Arthritis, Psoriatic/blood
- Arthritis, Psoriatic/immunology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Clonal Selection, Antigen-Mediated
- Gene Expression Profiling
- Humans
- Immunologic Memory
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Receptors, Chemokine/metabolism
- Receptors, Lymphocyte Homing/genetics
- Receptors, Lymphocyte Homing/metabolism
- Single-Cell Analysis
- Synovial Fluid/immunology
- Synovial Membrane/immunology
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Affiliation(s)
- Frank Penkava
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | | | | | - Nicole Yager
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Lilian N Nwosu
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Alicia Lledo Lara
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | | | - Ash Maroof
- UCB Pharma, 216 Bath road, Slough, SL1 3WE, UK
| | | | | | | | - Davide Simone
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Andrew Filer
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Institute of Inflammation and Ageing, Birmingham, UK
| | - Chrysothemis C Brown
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Andrew L Croxford
- Idorsia Pharmaceuticals Ltd., Drug Discovery Immunology, Hegenheimermattweg 91, 4123, Allschwill, Switzerland
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | | | - Paul Bowness
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton, CB10 1SA, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0SP, UK.
| | - M Hussein Al-Mossawi
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
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20
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Abstract
PURPOSE OF REVIEW This narrative review summarizes the last 5 years of published, peer-reviewed research on the use of musculoskeletal ultrasound (US) in osteoarthritis (OA). RECENT FINDINGS Multiple features relevant to OA can be visualized on US, including synovitis, erosion, enthesitis, osteophytes, cartilage damage, meniscal extrusion, and popliteal cysts. US can be used to confirm a diagnosis of OA or make an alternate diagnosis in the clinical setting. When a standardized protocol is used, US is a reliable modality for assessment of the features of OA. Findings on US can predict progression and response to therapy in OA of the hand and knee and can allow characterization of risk factors in a cost-effective, non-invasive, repeatable manner. US is becoming more widely used in OA imaging and has clear value in addition to radiography and clinical assessment. US will likely prove useful in defining phenotypes and providing treatment guidance in OA.
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Affiliation(s)
- Amanda E Nelson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.
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21
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Rivellese F, Humby F, Bugatti S, Fossati‐Jimack L, Rizvi H, Lucchesi D, Lliso‐Ribera G, Nerviani A, Hands RE, Giorli G, Frias B, Thorborn G, Jaworska E, John C, Goldmann K, Lewis MJ, Manzo A, Bombardieri M, Pitzalis C. B Cell Synovitis and Clinical Phenotypes in Rheumatoid Arthritis: Relationship to Disease Stages and Drug Exposure. Arthritis Rheumatol 2020; 72:714-725. [PMID: 31785084 PMCID: PMC7217046 DOI: 10.1002/art.41184] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To define the relationship of synovial B cells to clinical phenotypes at different stages of disease evolution and drug exposure in rheumatoid arthritis (RA). METHODS Synovial biopsy specimens and demographic and clinical data were collected from 2 RA cohorts (n = 329), one of patients with untreated early RA (n = 165) and one of patients with established RA with an inadequate response to tumor necrosis factor inhibitors (TNFi-IR; n = 164). Synovial tissue was subjected to hematoxylin and eosin and immunohistochemical staining and semiquantitative assessment for the degree of synovitis (on a scale of 0-9) and of CD20+ B cell infiltrate (on a scale of 0-4). B cell scores were validated by digital image analysis and B cell lineage-specific transcript analysis (RNA-Seq) in the early RA (n = 91) and TNFi-IR (n = 127) cohorts. Semiquantitative CD20 scores were used to classify patients as B cell rich (≥2) or B cell poor (<2). RESULTS Semiquantitative B cell scores correlated with digital image analysis quantitative measurements and B cell lineage-specific transcripts. B cell-rich synovitis was present in 35% of patients in the early RA cohort and 47.7% of patients in the TNFi-IR cohort (P = 0.025). B cell-rich patients showed higher levels of disease activity and seropositivity for rheumatoid factor and anti-citrullinated protein antibody in early RA but not in established RA, while significantly higher histologic synovitis scores in B cell-rich patients were demonstrated in both cohorts. CONCLUSION We describe a robust semiquantitative histologic B cell score that closely replicates the quantification of B cells by digital or molecular analyses. Our findings indicate an ongoing B cell-rich synovitis, which does not seem to be captured by standard clinimetric assessment, in a larger proportion of patients with established RA than early RA.
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Affiliation(s)
- F. Rivellese
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - F. Humby
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - S. Bugatti
- IRCCSPoliclinico San Matteo Foundation and University of PaviaPaviaItaly
| | - L. Fossati‐Jimack
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | | | - D. Lucchesi
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - G. Lliso‐Ribera
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - A. Nerviani
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - R. E. Hands
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - G. Giorli
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - B. Frias
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - G. Thorborn
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - E. Jaworska
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - C. John
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - K. Goldmann
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - M. J. Lewis
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - A. Manzo
- IRCCSPoliclinico San Matteo Foundation and University of PaviaPaviaItaly
| | - M. Bombardieri
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - C. Pitzalis
- Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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22
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Small A, Wechalekar MD. Synovial biopsies in inflammatory arthritis: precision medicine in rheumatoid arthritis. Expert Rev Mol Diagn 2020; 20:315-325. [PMID: 31865803 DOI: 10.1080/14737159.2020.1707671] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Synovial tissue (ST) is composed of a lining and sublining layer and is the target tissue involved in the inflammatory arthritides (IA), in which there is lining layer hyperplasia, inflammatory cell influx, macrophage recruitment and change in number and behavior of lining fibroblasts. Understanding synovial pathology has been critical in providing insights into pathogenetic mechanisms of disease and therapeutics. Pathobiological insights into ST have been underpinned by progress in molecular analytic methods; research in this area holds promise in individualizing treatment and optimizing response.Areas covered: We explore ST in IA and cover in-depth the utility of synovial biopsy and ST heterogeneity. We review recent advances in ST research and discuss implications with regards to therapeutic response. Finally, we provide perspectives on the identification of new drug targets and new diagnostic and prognostic markers.Expert opinion: ST holds the potential to individualize therapy by detecting biomarkers of diagnosis, therapeutic choice, and treatment modification in IA. Advances in molecular biology including high-throughput omics are likely to provide information that has hitherto remained unknown. ST analyzes pre- and post-treatment needs to be standard of care; only by routinely collecting and analyzing ST will we achieve the precision medicine outcomes described herein.
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Affiliation(s)
- Annabelle Small
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Mihir D Wechalekar
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia.,Rheumatology Department, Flinders Medical Centre, Adelaide, SA, Australia
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23
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Smits M, van de Groes S, Thurlings RM. Synovial Tissue Biopsy Collection by Rheumatologists: Ready for Clinical Implementation? Front Med (Lausanne) 2019; 6:138. [PMID: 31281817 PMCID: PMC6595539 DOI: 10.3389/fmed.2019.00138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
Synovial tissue from arthritis patients is increasingly used for both basic pathophysiological and clinical translational research. This development has been spurred by the development of biotechnological techniques for analysis of complex tissues and the validation of ultrasound guided biopsies for easier tissue sampling. This increasing use of synovial tissue raises questions on standardization of methodologies for tissue processing and cellular & molecular analyses. Furthermore, it raises the question if synovial tissue biopsy analysis may be more widely implemented in clinical practice, what are the methodological hurdles for implementation and what are the lessons that can be learned from previous experience. This will be the focus of this review.
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Affiliation(s)
- Marijn Smits
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rogier M Thurlings
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
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24
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Manzo A, Bugatti S, Rossi S. Clinical Applications of Synovial Biopsy. Front Med (Lausanne) 2019; 6:102. [PMID: 31134204 PMCID: PMC6524205 DOI: 10.3389/fmed.2019.00102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
The synovial tissue is a primary target of multiple diseases characterized by different pathogenic mechanisms, including infective, deposition, neoplastic, and chronic immune-inflammatory pathologies. Synovial biopsy can have a relevant role in differential diagnosis of specific conditions in clinical practice, although its exploitation remains relatively limited. In particular, no validated synovial-tissue-derived biomarkers are currently available in the clinic to aid in the diagnosis and management in most frequent forms of chronic inflammatory arthropathies, namely rheumatoid arthritis (RA) and the spondyloarthritides (SpA). In this brief review, we will discuss the current spectrum of clinical applications of synovial biopsy in routine rheumatologic care and will provide an analysis of the perspectives for its potential exploitation in patients with chronic inflammatory arthritides.
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Affiliation(s)
- Antonio Manzo
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Serena Bugatti
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Silvia Rossi
- Rheumatology and Translational Immunology Research Laboratories, Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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25
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Pritzker KPH, Nieminen HJ. Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care. Arch Pathol Lab Med 2019; 143:1399-1415. [PMID: 31100015 DOI: 10.5858/arpa.2018-0463-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT.— Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. OBJECTIVE.— To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. DATA SOURCES.— PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. CONCLUSIONS.— Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.
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Affiliation(s)
- Kenneth P H Pritzker
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
| | - Heikki J Nieminen
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
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26
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Polido-Pereira J. Ultrasound-Guided Biopsies: Medium and Large Joints. Front Med (Lausanne) 2019; 6:95. [PMID: 31165069 PMCID: PMC6536602 DOI: 10.3389/fmed.2019.00095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022] Open
Abstract
Ultrasound-guided needle synovial biopsies are useful for clinical practice and research in rheumatology. With the emergence of personalized medicine for the treatment of inflammatory rheumatic diseases, it is predicted that this technique will be increasingly used in the near future. Standardized characterization of the technical aspects of ultrasound-guided needle synovial biopsies is needed in order to produce solid evidence on the safety and effectiveness of the technique.
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Affiliation(s)
- Joaquim Polido-Pereira
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Lisbon, Portugal.,Unidade de Investigação em Reumatologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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27
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Humby FC. Synovial Tissue Sampling in Rheumatological Practice-Past Developments and Future Perspectives. Front Med (Lausanne) 2019; 6:4. [PMID: 30761301 PMCID: PMC6361834 DOI: 10.3389/fmed.2019.00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
Synovial biopsies are performed in routine clinical care in order to refine diagnosis as well as within a research setting. Progress in the development of minimally invasive synovial sampling methods in the last century has accelerated and facilitated novel insights into disease pathogenesis. This review discusses the development of synovial biopsy techniques as well as examining the three currently most commonly used approaches: arthroscopic, blind needle biopsy and ultrasound guided approaches. It also highlights major research advances driven through synovial research and considers future developments.
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Affiliation(s)
- Frances C Humby
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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28
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Lazarou I, Kelly SG, Meric de Bellefon L. Ultrasound-Guided Synovial Biopsies of Wrists, Metacarpophalangeal, Metatarsophalangeal, Interphalangeal Joints, and Tendon Sheaths. Front Med (Lausanne) 2019; 6:2. [PMID: 30719434 PMCID: PMC6348247 DOI: 10.3389/fmed.2019.00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 11/23/2022] Open
Abstract
Ultrasound-guided synovial biopsy (UGSB) is a minimally-invasive procedure which allows quality synovial tissue retrieval. In this article, we will discuss overarching principles of the procedure performed in wrists, metacarpophalangeal (MCP), metatarsophalangeal (MTP), interphalangeal joints (IP), and tendon sheaths, including basic sonoanatomy, entry site and biopsy technique, as well as special considerations for each structure whenever relevant.
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Affiliation(s)
- Ilias Lazarou
- Department of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Stephen Gerard Kelly
- Department of Rheumatology, Barts Health NHS Trust, Mile End Hospital, London, United Kingdom
| | - Laurent Meric de Bellefon
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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