Best Practice & Research Clinical Rheumatology
Volume 23, Issue 2 , Pages 221-232 , April 2009

How to perform and analyse synovial biopsies

  • Daniëlle M. Gerlag, MD, PhD (Doctor)

      Affiliations

    • Corresponding Author InformationCorresponding author. Division of Clinical Immunology and Rheumatology, F4-218, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. Tel.: +31 20 5662171; Fax: +31 20 6919658.
  • ,
  • Paul P. Tak, MD, PhD (Professor)

References 

  1. Gerlag DM, Tak PP. How useful are synovial biopsies for the diagnosis of rheumatic diseases?. Nat Clin Pract Rheumatol. 2007 May;3(5):248–249
  2. van der Heijden I, Wilbrink B, Vije AE, et al. Detection of bacterial DNA in serial synovial samples obtained during antibiotic treatment from patients with septic arthritis. Arthritis Rheum. 1999 Oct;42(10):2198–2203
  3. van der Heijden I, Wilbrink B, Rijpkema SG, et al. Detection of Borrelia burgdorferi sensu stricto by reverse line blot in the joints of Dutch patients with Lyme arthritis. Arthritis Rheum. 1999 Jul;42(7):1473–1480
  4. van der Heijden I, Wilbrink B, Schouls LM, et al. Detection of mycobacteria in joint samples from patients with arthritis using a genus-specific polymerase chain reaction and sequence analysis. Rheumatology (Oxford). 1999 Jun;38(6):547–553
  5. Kroot EJ, Weel AE, Hazes JM, et al. Diagnostic value of blind synovial biopsy in clinical practice. Rheumatology (Oxford). 2006 Feb;45(2):192–195
  6. van der Horst-Bruinsma IE, Speyer I, Visser H, et al. Diagnosis and course of early-onset arthritis: results of a special early arthritis clinic compared to routine patient care. Br J Rheumatol. 1998 Oct;37(10):1084–1088
  7. Kraan MC, Haringman JJ, Post WJ, et al. Immunohistological analysis of synovial tissue for differential diagnosis in early arthritis. Rheumatology (Oxford). 1999 Nov;38(11):1074–1080
  8. Baeten D, Demetter P, Cuvelier C, et al. Comparative study of the synovial histology in rheumatoid arthritis, spondyloarthropathy, and osteoarthritis: influence of disease duration and activity. Ann Rheum Dis. 2000 Dec;59(12):945–953
  9. Kruithof E, Van den Bossche V, De Rycke L, et al. Distinct synovial immunopathologic characteristics of juvenile-onset spondylarthritis and other forms of juvenile idiopathic arthritis. Arthritis Rheum. 2006 Aug;54(8):2594–2604
  10. van der Pouw Kraan TC, van Gaalen FA, Kasperkovitz PV, et al. Rheumatoid arthritis is a heterogeneous disease: evidence for differences in the activation of the STAT-1 pathway between rheumatoid tissues. Arthritis Rheum. 2003 Aug;48(8):2132–2145
  11. Gerlag DM, Tak PP. Novel approaches for the treatment of rheumatoid arthritis: lessons from the evaluation of synovial biomarkers in clinical trials. Best Pract Res Clin Rheumatol. 2008 Apr;22(2):311–323
  12. Thurlings RM, Vos K, Wijbrandts CA, et al. Synovial tissue response to rituximab: mechanism of action and identification of biomarkers of response. Ann Rheum Dis. 2007 Oct 26;
  13. Gerlag DM, Haringman JJ, Smeets TJ, et al. Effects of oral prednisolone on biomarkers in synovial tissue and clinical improvement in rheumatoid arthritis. Arthritis Rheum. 2004 Dec;50(12):3783–3791
  14. Haringman JJ, Gerlag DM, Zwinderman AH, et al. Synovial tissue macrophages: a sensitive biomarker for response to treatment in patients with rheumatoid arthritis. Ann Rheum Dis. 2005 Jun;64(6):834–838
  15. Wijbrandts CA, Vergunst CE, Haringman JJ, et al. Absence of changes in the number of synovial sublining macrophages after ineffective treatment for rheumatoid arthritis: Implications for use of synovial sublining macrophages as a biomarker. Arthritis Rheum. 2007 Nov;56(11):3869–3871
  16. van Kuijk AW, Gerlag DM, Vos K, et al. A prospective, randomized, placebo-controlled study to identify biomarkers associated with active treatment in psoriatic arthritis: effects of adalimumab treatment on synovial tissue. Ann Rheum Dis. 2008 Jul 22;
  17. Pontifex EK, Gogarty M, Gibbs A, et al. Change in CD3 positive cell infiltration in psoriatic arthritis (PsA) synovial tissue correlates with change in DAS28 following initiation of biologis therapy. Ann Rheum Dis. 2008;67(Suppl II):628
  18. Gerlag D, Tak PP. Synovial biopsy. Best Pract Res Clin Rheumatol. 2005 Jun;19(3):387–400
  19. Kraan MC, Reece RJ, Smeets TJ, et al. Comparison of synovial tissues from the knee joints and the small joints of rheumatoid arthritis patients: implications for pathogenesis and evaluation of treatment. Arthritis Rheum. 2002 Aug;46(8):2034–2038
  20. Kane D, Veale DJ, Fitzgerald O, Reece R. Survey of arthroscopy performed by rheumatologists. Rheumatology (Oxford). 2002 Feb;41(2):210–215
  21. Lindblad S, Hedfors E. Intraarticular variation in synovitis. Local macroscopic and microscopic signs of inflammatory activity are significantly correlated. Arthritis Rheum. 1985 Sep;28(9):977–986
  22. Rooney M, Condell D, Quinlan W, et al. Analysis of the histologic variation of synovitis in rheumatoid arthritis. Arthritis Rheum. 1988 Aug;31(8):956–963
  23. Youssef PP, Kraan M, Breedveld F, et al. Quantitative microscopic analysis of inflammation in rheumatoid arthritis synovial membrane samples selected at arthroscopy compared with samples obtained blindly by needle biopsy. Arthritis Rheum. 1998 Apr;41(4):663–669
  24. Baeten D, Van den Bosch F, Elewaut D, et al. Needle arthroscopy of the knee with synovial biopsy sampling: technical experience in 150 patients. Clin Rheumatol. 1999;18(6):434–441
  25. Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002 Jul 11;347(2):81–88
  26. Van Oosterhout M, Sont JK, Van Laar JM. Superior effect of arthroscopic lavage compared with needle aspiration in the treatment of inflammatory arthritis of the knee. Rheumatology (Oxford). 2003 Jan;42(1):102–107
  27. Tanaka N, Sakahashi H, Sato E, et al. Effects of needle-arthroscopic lavage with different volumes of fluid on knee synovitis in rheumatoid arthritis. Clin Rheumatol. 2002 Feb;21(1):4–9
  28. Tanaka N, Sakahashi H, Hirose K, et al. Volume of a wash and the other conditions for maximum therapeutic effect of arthroscopic lavage in rheumatoid knees. Clin Rheumatol. 2006 Feb;25(1):65–69
  29. Scire CA, Epis O, Codullo V, et al. Immunohistological assessment of the synovial tissue in small joints in rheumatoid arthritis: validation of a minimally invasive ultrasound-guided synovial biopsy procedure. Arthritis Res Ther. 2007;9(5):R101
  30. Koski JM, Helle M. Ultrasound guided synovial biopsy using portal and forceps. Ann Rheum Dis. 2005 Jun;64(6):926–929
  31. Taylor PC. The value of sensitive imaging modalities in rheumatoid arthritis. Arthritis Res Ther. 2003;5(5):210–213
  32. Wilbrink B, van der Heijden I, Schouls LM, et al. Detection of bacterial DNA in joint samples from patients with undifferentiated arthritis and reactive arthritis, using polymerase chain reaction with universal 16S ribosomal RNA primers. Arthritis Rheum. 1998 Mar;41(3):535–543
  33. Miossec P, Briolay J, Dechanet J, et al. Inhibition of the production of proinflammatory cytokines and immunoglobulins by interleukin-4 in an ex vivo model of rheumatoid synovitis. Arthritis Rheum. 1992 Aug;35(8):874–883
  34. Bresnihan B, Cunnane G, Youssef P, et al. Microscopic measurement of synovial membrane inflammation in rheumatoid arthritis: proposals for the evaluation of tissue samples by quantitative analysis. Br J Rheumatol. 1998 Jun;37(6):636–642
  35. Youssef PP, Triantafillou S, Parker A, et al. Variability in cytokine and cell adhesion molecule staining in arthroscopic synovial biopsies: quantification using color video image analysis. J Rheumatol. 1997 Dec;24(12):2291–2298
  36. Kraan MC, Smith MD, Weedon H, et al. Measurement of cytokine and adhesion molecule expression in synovial tissue by digital image analysis. Ann Rheum Dis. 2001 Mar;60(3):296–298
  37. Dolhain RJ, Ter Haar NT, De Kuiper R, et al. Distribution of T cells and signs of T-cell activation in the rheumatoid joint: implications for semiquantitative comparative histology. Br J Rheumatol. 1998 Mar;37(3):324–330
  38. Smeets TJ, Kraan MC, Galjaard S, et al. Analysis of the cell infiltrate and expression of matrix metalloproteinases and granzyme B in paired synovial biopsy specimens from the cartilage-pannus junction in patients with RA. Ann Rheum Dis. 2001 Jun;60(6):561–565
  39. Kirkham B, Portek I, Lee CS, et al. Intraarticular variability of synovial membrane histology, immunohistology, and cytokine mRNA expression in patients with rheumatoid arthritis. J Rheumatol. 1999 Apr;26(4):777–784
  40. Tak PP, Smeets TJ, Daha MR, et al. Analysis of the synovial cell infiltrate in early rheumatoid synovial tissue in relation to local disease activity. Arthritis Rheum. 1997 Feb;40(2):217–225
  41. Ulfgren AK, Grondal L, Lindblad S, et al. Interindividual and intra-articular variation of proinflammatory cytokines in patients with rheumatoid arthritis: potential implications for treatment. Ann Rheum Dis. 2000 Jun;59(6):439–447
  42. Klimiuk PA, Goronzy JJ, Bjor NJ, et al. Tissue cytokine patterns distinguish variants of rheumatoid synovitis. Am J Pathol. 1997 Nov;151(5):1311–1319
  43. Thurlings RM, Wijbrandts CA, Mebius RE, et al. Synovial lymphoid neogenesis does not define a specific clinical rheumatoid arthritis phenotype. Arthritis Rheum. 2008 Jun;58(6):1582–1589
  44. Kraan MC, Haringman JJ, Ahern MJ, et al. Quantification of the cell infiltrate in synovial tissue by digital image analysis. Rheumatology (Oxford). 2000 Jan;39(1):43–49
  45. Youssef PP, Smeets TJ, Bresnihan B, et al. Microscopic measurement of cellular infiltration in the rheumatoid arthritis synovial membrane: a comparison of semiquantitative and quantitative analysis. Br J Rheumatol. 1998 Sep;37(9):1003–1007
  46. Cunnane G, Bjork L, Ulfgren AK, et al. Quantitative analysis of synovial membrane inflammation: a comparison between automated and conventional microscopic measurements. Ann Rheum Dis. 1999 Aug;58(8):493–499
  47. van der Hall PO, Kraan MC, Tak PP. Quantitative image analysis of synovial tissue. Methods Mol Med. 2007;135:121–143
  48. Haringman JJ, Vinkenoog M, Gerlag DM, et al. Reliability of computerized image analysis for the evaluation of serial synovial biopsies in randomized controlled trials in rheumatoid arthritis. Arthritis Res Ther. 2005;7(4):R862–R867
  49. Boyle DL, Rosengren S, Bugbee W, et al. Quantitative biomarker analysis of synovial gene expression by real-time PCR. Arthritis Res Ther. 2003;5(6):R352–R360
  50. van der Pouw Kraan TC, van Gaalen FA, Huizinga TW, et al. Discovery of distinctive gene expression profiles in rheumatoid synovium using cDNA microarray technology: evidence for the existence of multiple pathways of tissue destruction and repair. Genes Immun. 2003 Apr;4(3):187–196
  51. Judex M, Neumann E, Lechner S, et al. Laser-mediated microdissection facilitates analysis of area-specific gene expression in rheumatoid synovium. Arthritis Rheum. 2003 Jan;48(1):97–102
  52. Hashimoto A, Matsui T, Tanaka S, et al. Laser-mediated microdissection for analysis of gene expression in synovial tissue. Mod Rheumatol. 2007;17(3):185–190
  53. Muller-Ladner U, Judex M, Neumann E, Gay S. Laser capture as a tool for analysis of gene expression in inflamed synovium. Methods Mol Med. 2007;135:91–104

PII: S1521-6942(09)00006-0

doi: 10.1016/j.berh.2009.01.006

Best Practice & Research Clinical Rheumatology
Volume 23, Issue 2 , Pages 221-232 , April 2009