Arthroscopic Guided Synovial Biopsies

Orr, Carl; Vieira-Sousa, Elsa; Fonseca, João Eurico; Veale, Douglas J.

doi:10.3389/fmed.2020.604582

“…In part due to lessons learned from arthroscopy, rheumatology stands on the brink of true “precision medicine”, with treatments tailored to specific individual characteristics of each patient 210,211 . It remains generally accepted that arthroscopy is the gold standard for assessing and obtaining the synovium that would guide such therapy, 212,213 particularly since the variability in synovial characteristics cannot be accounted for by externally guided sampling 214 . Means to assess synovial tissue are about to take another quantum leap 215 .…”

Section: Discussionmentioning

confidence: 99%

Will rheumatologists ever pick up the arthroscope again?

Ike

¹

,

Kalunian

²

2021

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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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“…Arthroscopy and synovial biopsy was performed in a sub-group of patients prior to treatment under local anaesthesia using a Wolf 2.7mm arthroscope, as previously described [33]. Patients were selected for arthroscopy based on the presence of active knee synovitis and provided written, fully informed consent for the procedure.…”

Section: Arthroscopymentioning

confidence: 99%

Synovial Tissue Lymphoid Aggregates Are Associated With Response To Rituximab Therapy In Rheumatoid Arthritis Patients

Turk

¹

,

Low

²

,

Orr

³

et al. 2022

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Background: To evaluate the clinical and laboratory factors associated with long-term responses to rituximab therapy in patients with RA. Methods: One hundred fourteen RA patients received intravenous Rituximab between 2003-2016. Prior to treatment, arthroscopy and synovial biopsy was performed on a subgroup of this cohort who had active knee arthritis. Demographic, clinical, and outcome data were collected prospectively and immunohistology was performed on synovial tissue biopsies.Results: In the overall cohort, 89% of patients were seropositive for either RF (rheumatoid factor) or ACPA (anti-citrullinated protein antibodies). At baseline, median disease duration was 13.5 years. Seventy-four percent of patients had received a csDMARD and two thirds had received a bDMARD before rituximab. Rituximab monotherapy was used in 34 patients, while 80 patients received rituximab-csDMARD combination therapy. Twenty-six of the 68 patients in remission (38%) received rituximab monotherapy and 42/68 (62%) received combination therapy with a csDMARD. Twenty-four of 39 (62%) biologic naïve patients achieved remission on treatment with rituximab. Forty-four patients underwent an arthroscopy and synovial biopsy prior to treatment. Synovial tissue lymphoid aggregates (LA) were observed in 21 subjects, of which 17 (81%) showed complete or partial remission in response to treatment with rituximab. The presence of LA was significantly associated with rituximab-induced remission in these patients (p=0.007, OR=7.286 [1.737-30.555]). Conclusion: In this real world series, patients with RA demonstrate long-term, high response rates to rituximab therapy and synovial biopsy B-cell rich lymphoid aggregates are associated with a higher rate of good response.

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Synovial Tissue Lymphoid Aggregates Are Associated With Response To Rituximab Therapy In Rheumatoid Arthritis Patients

Turk

¹

,

Low

²

,

Orr

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Background: To evaluate the clinical and laboratory factors associated with long-term responses to rituximab therapy in patients with RA. Methods: One hundred fourteen RA patients received intravenous Rituximab between 2003-2016. Prior to treatment, arthroscopy and synovial biopsy was performed on a subgroup of this cohort who had active knee arthritis. Demographic, clinical, and outcome data were collected prospectively and immunohistology was performed on synovial tissue biopsies.Results: In the overall cohort, 89% of patients were seropositive for either RF (rheumatoid factor) or ACPA (anti-citrullinated protein antibodies). At baseline, median disease duration was 13.5 years. Seventy-four percent of patients had received a csDMARD and two thirds had received a bDMARD before rituximab. Rituximab monotherapy was used in 34 patients, while 80 patients received rituximab-csDMARD combination therapy. Twenty-six of the 68 patients in remission (38%) received rituximab monotherapy and 42/68 (62%) received combination therapy with a csDMARD. Twenty-four of 39 (62%) biologic naïve patients achieved remission on treatment with rituximab. Forty-four patients underwent an arthroscopy and synovial biopsy prior to treatment. Synovial tissue lymphoid aggregates (LA) were observed in 21 subjects, of which 17 (81%) showed complete or partial remission in response to treatment with rituximab. The presence of LA was significantly associated with rituximab-induced remission in these patients (p=0.007, OR=7.286 [1.737-30.555]). Conclusion: In this real world series, patients with RA demonstrate long-term, high response rates to rituximab therapy and synovial biopsy B-cell rich lymphoid aggregates are associated with a higher rate of good response.

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Arthroscopic Guided Synovial Biopsies

Cited by 3 publications

References 26 publications

Will rheumatologists ever pick up the arthroscope again?

Will rheumatologists ever pick up the arthroscope again?

Synovial Tissue Lymphoid Aggregates Are Associated With Response To Rituximab Therapy In Rheumatoid Arthritis Patients

Synovial Tissue Lymphoid Aggregates Are Associated With Response To Rituximab Therapy In Rheumatoid Arthritis Patients

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