Abstract
Synovial tissue can be safely and reliably collected for research and clinical purposes using arthroscopy. This technique offers the obvious advantage of allowing direct visualization, and targeted biopsy of specific areas of interest within the joint, as well as for the collection of tissue which will include a lining layer. Much has been learnt by studying the synovium retrieved using this technique concerning the pathobiology of inflammatory arthritis. Furthermore, recent evidence suggests that the tissue retrieved may enable the identification of unique pathotypes that will allow for a precise approach to treatment selection in individual patients. Although ultrasound guided techniques for sampling synovial tissue have gained in popularity over the last decade, both methodologies are expected to compliment each other, each having unique benefits and drawbacks. We present here a detailed description of the arthroscopy technique reporting on our collective experience at two centers in Europe.
Highlights
The synovium is the primary target tissue in inflammatory arthritis (IA), and it follows that analysis of this tissue must yield important clues to advance our understanding of the underlying pathobiology of these heterogenous diseases
We describe the general aspects of the technique of arthroscopic guided synovial biopsies (AGSB) of the knee joint under local anesthetic, as performed in two European Rheumatology Centers: St
AGSB as performed by rheumatologists is a safe and reliable technique for sampling synovial tissue that is most suited to large joints
Summary
The synovium is the primary target tissue in inflammatory arthritis (IA), and it follows that analysis of this tissue must yield important clues to advance our understanding of the underlying pathobiology of these heterogenous diseases. Arthroscopy was adopted by Rheumatologists to allow ST sampling at varying points in the disease course and has long been the favored technique historically This technique has the advantage of providing direct intra-articular visualization of synovium as well as a therapeutic joint lavage. A detailed patient’s medical history is collected and a plain film radiograph of the knee is requested (if not available) as well as laboratorial evaluation including coagulation parameters Antiaggregant such as clopidogrel and direct oral anti-coagulants or warfarin, are contraindicated unless these can safely be discontinued for an appropriate time before the procedure or occasionally replaced by low molecular weight heparin
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