15A141

How ultrasound guided synovial biopsies can help in clinical practice?

Author(s)

Najm A1, Heymann M.F2, Maugars Y1, Orr C3, Veale DJ3, Le Goff B1

Department(s)/Institutions

1Rheumatology, CHU Nantes, NANTES, France 2Histopathology, CHU Nantes, NANTES, France 3Rheumatology, Saint Vincent’s Hospital, Dublin, Ireland

Introduction

Histological and bacteriological analysis of synovial tissue can be useful in the diagnosis of arthritis of undetermined origin. Ultrasound (US) can assist this biopsy in directing the needle within the joint as well as allowing an evaluation of synovial inflammation and thickness.

Aims/Background

The aims of this study were to describe the indications for US guided synovial biopsies in clinical practice, to determine the rate of success in acquiring synovial tissue using this approach and to determine how frequently the synovial biopsy can lead to a definite diagnosis.

Method

Results

Seventy-three patients underwent 75 ultrasound guided biopsy procedures. Fifty-three per cents were men and average age was 57,9 years (+/- 17,2). Biopsies were performed in the following joints: 42 knees, 7 wrists, 6 ankles, 6 hips, 3 shoulders, 3 sterno-clavicular joints, 3 elbows, 2 metatarsophalangeal joints, 1 pubic symphysis, 1 acromio-clavicular joint and 1 fibular tenosynovitis. Patients presented a chronic (>3 months) monoarthritis in 42 cases (56%), an acute monoarthritis in 18 cases (24%), a chronic polyarthritis in 13 cases (18%), an acute polyarthritis, a chronic tenosynovitis in 1 case respectively. US guided biopsy attempt succeeded in 85% of cases (64 on 75 biopsies performed). There was no difference on success rate between small and large joints. Ten of the 64 biopsies (16% of patients) leaded to a definitive diagnosis (2 septic arthritis, 2 villonodular synovitis, 1 amyloid arthritis, 1 joint localization of a man tle cell lymphoma, 1 gouty arthritis, 1 osteochondromatosis, 1 Whipple disease (positive PCR on synovial tissue, with negative PCR on synovial fluid) and 1 Lyme arthritis. One patient presented a knee hemarthrosis 48 hours after the US guided biopsy.

Conclusions

Ultrasound guided synovial biopsies in clinical practice are performed on patients with heterogeneous features. Success rate in acquiring synovial tissue is high. The procedure leads to a definite diagnosis in more than 1 on 6 patients with arthritis of undetermined origin.