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.
Highlights
There are several possible approaches to the acquisition of synovial tissue [1, 2]
For large joints arthroscopic biopsy is generally accepted as the gold standard, which gives a good quality and size of biopsy specimens in most cases [3]
A relatively new method to obtain synovial tissue is ultrasound (US) guided synovial biopsy, which is performed by trained rheumatologists
Summary
There are several possible approaches to the acquisition of synovial tissue [1, 2]. In most clinical practices tissue acquisition is performed by orthopedic surgeons at the operating theater, with the patient under sufficient anesthesia. In a recent multicenter retrospective study comparing arthroscopic biopsies with ultra-sound guided and blind needle biopsies on 159 procedures from 5 different academic rheumatology centers, there was no significant difference in the proportion of graded synovial tissue or total graded synovial tissue area and containing enough RNA of significant quality and quantity for transcriptomic analysis [15]. These studies on tissue quality have only been investigated for a number of general assays, such as immunohistochemical staining of T cells and general retrieval of RNA. If a number of diagnostic tests are combined within one patient, it is not known if the synovial tissue yield is similar between the first vs. later biopsies
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