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A minimally invasive, ultrasound-guided biopsy technique safely harvested synovial tissue samples for immunohistochemical analysis and RNA extraction from both large and small joints of patients with inflammatory arthritis of less than 1 year duration in a small, single-center study.
Dr. Stephen Kelly of Mile End Hospital at Barts Health NHS Trust in London and his colleagues collected a median of 14 samples per procedure in 57 patients with a mean age of 50 years who were a part of the Pathobiology of Early Arthritis Cohort, a multicenter consortium that recruits patients in the early stages of arthritis. Clinical diagnoses in the patients included rheumatoid arthritis (40); psoriatic arthritis (6); undifferentiated arthritis (10); and monoarthritis (1). The investigators took tissue from the knee, elbow, and wrist, as well as metacarpal phalangeal and proximal interphalangeal joints (Ann. Rheum. Dis. 2013 Dec. 13 [doi:10.1136/annrheumdis-2013-204603]).
Synovial tissue biopsies are performed to collect RNA, identify tissue damage, and monitor early stages of rheumatoid arthritis and other joint disorders. The procedure is usually done using a blind needle examination – the simplest of biopsy options – or with arthroscopy, which the authors argue is a more complicated procedure and can target only larger joints (which is not a problem with the ultrasound-guided procedure). Although arthroscopy is still the ‘gold standard’ for joint tissue collection, the ability to conduct minimally invasive synovial tissue sampling would benefit research and drug development, as well as potentially assisting diagnosis, classification, and monitoring of treatment.
The investigators recorded no major complications and only mild pain or discomfort in 93 procedures in the patients, including 36 who participated in a follow-up procedure. In addition, 86 of the biopsies (93%) yielded high-quality tissue samples, on par with other ultrasound extraction methods like renal biopsies in which suitable tissue for analysis is obtained in 83%-97% of reported cases.
At a follow-up visit 3-7 days after the procedure, the patients did not have infection, hemarthrosis, deep venous thrombosis, thrombophlebitis, or flare of the underlying disease. A total of 18 patients reported mild arthralgia after the procedure, but this resolved within 24 hours with simple analgesia. Although 36 of the 57 patients initially agreed to a follow-up procedure at 6 months, an additional 18 patients also agreed after the database for this study’s analysis had been closed. These results lend additional validation to the good safety and tolerability findings from an initial proof of concept study in nine patients with established rheumatoid arthritis (Arthritis Res. Ther. 2007;9:R101).
The study was supported by a grant from the Medical Research Council, and Dr. Kelly reported receiving a Clinical Research Fellowship from Arthritis Research UK.
A minimally invasive, ultrasound-guided biopsy technique safely harvested synovial tissue samples for immunohistochemical analysis and RNA extraction from both large and small joints of patients with inflammatory arthritis of less than 1 year duration in a small, single-center study.
Dr. Stephen Kelly of Mile End Hospital at Barts Health NHS Trust in London and his colleagues collected a median of 14 samples per procedure in 57 patients with a mean age of 50 years who were a part of the Pathobiology of Early Arthritis Cohort, a multicenter consortium that recruits patients in the early stages of arthritis. Clinical diagnoses in the patients included rheumatoid arthritis (40); psoriatic arthritis (6); undifferentiated arthritis (10); and monoarthritis (1). The investigators took tissue from the knee, elbow, and wrist, as well as metacarpal phalangeal and proximal interphalangeal joints (Ann. Rheum. Dis. 2013 Dec. 13 [doi:10.1136/annrheumdis-2013-204603]).
Synovial tissue biopsies are performed to collect RNA, identify tissue damage, and monitor early stages of rheumatoid arthritis and other joint disorders. The procedure is usually done using a blind needle examination – the simplest of biopsy options – or with arthroscopy, which the authors argue is a more complicated procedure and can target only larger joints (which is not a problem with the ultrasound-guided procedure). Although arthroscopy is still the ‘gold standard’ for joint tissue collection, the ability to conduct minimally invasive synovial tissue sampling would benefit research and drug development, as well as potentially assisting diagnosis, classification, and monitoring of treatment.
The investigators recorded no major complications and only mild pain or discomfort in 93 procedures in the patients, including 36 who participated in a follow-up procedure. In addition, 86 of the biopsies (93%) yielded high-quality tissue samples, on par with other ultrasound extraction methods like renal biopsies in which suitable tissue for analysis is obtained in 83%-97% of reported cases.
At a follow-up visit 3-7 days after the procedure, the patients did not have infection, hemarthrosis, deep venous thrombosis, thrombophlebitis, or flare of the underlying disease. A total of 18 patients reported mild arthralgia after the procedure, but this resolved within 24 hours with simple analgesia. Although 36 of the 57 patients initially agreed to a follow-up procedure at 6 months, an additional 18 patients also agreed after the database for this study’s analysis had been closed. These results lend additional validation to the good safety and tolerability findings from an initial proof of concept study in nine patients with established rheumatoid arthritis (Arthritis Res. Ther. 2007;9:R101).
The study was supported by a grant from the Medical Research Council, and Dr. Kelly reported receiving a Clinical Research Fellowship from Arthritis Research UK.
A minimally invasive, ultrasound-guided biopsy technique safely harvested synovial tissue samples for immunohistochemical analysis and RNA extraction from both large and small joints of patients with inflammatory arthritis of less than 1 year duration in a small, single-center study.
Dr. Stephen Kelly of Mile End Hospital at Barts Health NHS Trust in London and his colleagues collected a median of 14 samples per procedure in 57 patients with a mean age of 50 years who were a part of the Pathobiology of Early Arthritis Cohort, a multicenter consortium that recruits patients in the early stages of arthritis. Clinical diagnoses in the patients included rheumatoid arthritis (40); psoriatic arthritis (6); undifferentiated arthritis (10); and monoarthritis (1). The investigators took tissue from the knee, elbow, and wrist, as well as metacarpal phalangeal and proximal interphalangeal joints (Ann. Rheum. Dis. 2013 Dec. 13 [doi:10.1136/annrheumdis-2013-204603]).
Synovial tissue biopsies are performed to collect RNA, identify tissue damage, and monitor early stages of rheumatoid arthritis and other joint disorders. The procedure is usually done using a blind needle examination – the simplest of biopsy options – or with arthroscopy, which the authors argue is a more complicated procedure and can target only larger joints (which is not a problem with the ultrasound-guided procedure). Although arthroscopy is still the ‘gold standard’ for joint tissue collection, the ability to conduct minimally invasive synovial tissue sampling would benefit research and drug development, as well as potentially assisting diagnosis, classification, and monitoring of treatment.
The investigators recorded no major complications and only mild pain or discomfort in 93 procedures in the patients, including 36 who participated in a follow-up procedure. In addition, 86 of the biopsies (93%) yielded high-quality tissue samples, on par with other ultrasound extraction methods like renal biopsies in which suitable tissue for analysis is obtained in 83%-97% of reported cases.
At a follow-up visit 3-7 days after the procedure, the patients did not have infection, hemarthrosis, deep venous thrombosis, thrombophlebitis, or flare of the underlying disease. A total of 18 patients reported mild arthralgia after the procedure, but this resolved within 24 hours with simple analgesia. Although 36 of the 57 patients initially agreed to a follow-up procedure at 6 months, an additional 18 patients also agreed after the database for this study’s analysis had been closed. These results lend additional validation to the good safety and tolerability findings from an initial proof of concept study in nine patients with established rheumatoid arthritis (Arthritis Res. Ther. 2007;9:R101).
The study was supported by a grant from the Medical Research Council, and Dr. Kelly reported receiving a Clinical Research Fellowship from Arthritis Research UK.
FROM ANNALS OF THE RHEUMATIC DISEASES
Major finding: A total of 93% of ultrasound-guided tissue biopsies resulted in high-quality tissue samples, and a median of 14 biopsy samples were obtained from each procedure without significant complications following the procedure.
Data source: A single-center study of 57 patients with early arthritis in the Pathobiology of Early Arthritis Cohort.
Disclosures: The study was supported by a grant from the Medical Research Council, and Dr. Kelly reported receiving a Clinical Research Fellowship from Arthritis Research UK.