Clinical Applications of Synovial Biopsy

Manzo, Antonio; Bugatti, Serena; Rossi, Silvia

doi:10.3389/fmed.2019.00102

Cited by 5 publications

(6 citation statements)

References 121 publications

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“…The synovial biopsy is considered the final and last choice for establishing the diagnosis of chronic monoarthritis. It is assumed that in cases of undifferentiated arthritis, a synovial biopsy can facilitate the diagnostic process [ 6 , 14 ]. Results of our study showed that synovial biopsy could establish a definite diagnosis in one-third of cases with undifferentiated chronic knee monoarthritis.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the mentioned categories, undifferentiated arthritis refers to the condition that arthritis could not be categorized as rheumatoid arthritis or other classes of definite arthritis. Undifferentiated arthritis might indicate the early phase of an established disease or remain an entity that does not fit into any category of rheumatologic diagnoses [ 6 , 7 ]. Establishing a definite diagnosis for undifferentiated arthritis disorders is a long-standing challenge in rheumatology.…”

Section: Introductionmentioning

confidence: 99%

“…Histopathological examination of synovial specimens may be valuable in making an early diagnosis [ 9 ]. In addition to the diagnosis, findings of synovial biopsy have prognostic value [ 6 , 10 ] and alter under response to the treatment [ 11 ]. It is reported that, specifically in undifferentiated arthritis, synovial tissue biopsy can facilitate the diagnostic process [ 6 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…As the diagnosis of chronic undifferentiated monoarthritis is problematic, synovial tissue biopsy might offer valuable information as the last diagnostic utility and aid in reaching a precision medicine approach. Synovial biopsy findings are not extensively reviewed in the literature for chronic knee monoarthritis [ 6 , 7 ]. Thus, we aimed to evaluate synovial tissue biopsy’s clinical implication and efficacy for establishing definite diagnoses in patients previously labeled as having chronic undifferentiated knee monoarthritis.…”

Section: Introductionmentioning

confidence: 99%

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Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis

Soroosh

Ghatfan

Farbod

et al. 2023

BMC Musculoskelet Disord

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis

Soroosh

Ghatfan

Farbod

et al. 2023

BMC Musculoskelet Disord

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show abstract

“…Irrespective of the clinical diagnosis, the synovial membrane in the course of chronic inflammatory arthritis is characterized by a number of common histopathological changes, including neoangiogenesis, proliferation and activation of the tissue stroma, and infiltration of the sublining layer by cells of the innate and adaptive immune system [124][125][126][127]. Notwithstanding these general similarities, synovial inflammatory features greatly vary in terms of cellular composition and reciprocal spatial arrangements across different disease entities and within a same disease, possibly reflecting divergent pathogenetic pathways [128,129].…”

Section: Synovial Pathologymentioning

confidence: 99%

The Genetic, Environmental, and Immunopathological Complexity of Autoantibody-Negative Rheumatoid Arthritis

Stefano

D’Onofrio

Manzo

et al. 2021

IJMS

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Differences in clinical presentation, response to treatment, and long-term outcomes between autoantibody-positive and -negative rheumatoid arthritis (RA) highlight the need for a better comprehension of the immunopathogenic events underlying the two disease subtypes. Whilst the drivers and perpetuators of autoimmunity in autoantibody-positive RA have started to be disclosed, autoantibody-negative RA remains puzzling, also due its wide phenotypic heterogeneity and its possible misdiagnosis. Genetic susceptibility appears to mostly rely on class I HLA genes and a number of yet unidentified non-HLA loci. On the background of such variable genetic predisposition, multiple exogeneous, endogenous, and stochastic factors, some of which are not shared with autoantibody-positive RA, contribute to the onset of the inflammatory cascade. In a proportion of the patients, the immunopathology of synovitis, at least in the initial stages, appears largely myeloid driven, with abundant production of proinflammatory cytokines and only minor involvement of cells of the adaptive immune system. Better understanding of the complexity of autoantibody-negative RA is still needed in order to open new avenues for targeted intervention and improve clinical outcomes.

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Preliminary study on immune cells in the synovium of end-stage osteoarthritis and rheumatoid arthritis patients: neutrophils and IgG4-secreting plasma cells as differential diagnosis candidates

et al. 2022

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Clinical Applications of Synovial Biopsy

Cited by 5 publications

References 121 publications

Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis

Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis

The Genetic, Environmental, and Immunopathological Complexity of Autoantibody-Negative Rheumatoid Arthritis

Preliminary study on immune cells in the synovium of end-stage osteoarthritis and rheumatoid arthritis patients: neutrophils and IgG4-secreting plasma cells as differential diagnosis candidates

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