Safety and tolerability of ultrasound-guided synovial needle biopsy in Japanese arthritis patients

Abstract

Objectives

We sought to clarify the safety and tolerability of ultrasound (US)-guided synovial needle biopsy in hand and knee joints in Japanese arthritis patients.

Methods

A total of nine consecutive arthritis patients were recruited and scheduled for US-guided synovial needle biopsies. Patients completed a safety questionnaire and patient-reported outcomes (PRO) data of joint pain, stiffness, and swelling pre- and postbiopsy. We also recorded patients’ characteristics and willingness to undergo a second biopsy by the same technique. All synovial needle biopsy samples were assessed with pathological and microbial examination to verify whether clinical evaluation was possible.

Results

Five and 4 patients underwent US-guided biopsy from hand and knee joints, respectively. PRO data showed no significant differences in pain, swelling, or stiffness levels before and after biopsy, with a mean 11.8 samples collected per procedure. No significant complications, including joint infection, bleeding, or vasovagal signs, were reported. Histologically adequate synovial tissue was identified in 83 (78%) samples. We were able to submit the biopsy samples to pathological and bacterial analysis to exclude septic arthritis.

Conclusion

We demonstrated that a minimally invasive US-guided needle biopsy is a safe and well-tolerated procedure and the synovial tissue collected was of adequate quality for pathological analysis.

Keywords:

• Arthritides;
• biopsy;
• invasiveness;
• synovium;
• ultrasound guidance

Acknowledgments

The authors would particularly like to thank Harumi Kondo for her assistance. We also would like to thank the Clinical Anatomy Laboratory, School of Medicine, Keio University for providing fresh cadavers for training in US-guided synovial biopsy. The authors are grateful to Nobuaki Imanishi, MD, PhD for approving the use of the laboratory for useful discussions. We thank Libby Cone, MD, MA, from DMC Japan http://www.dmed.co.jp for editing a draft of this manuscript.

Conflict of interest

YaK, KaS, YI, KoS, CT and YuKhave no conflicts of interest. TT has received research grants from Abbvie, Astra Zeneca, Bristol Myers Squibb, Chugai Pharmaceutical, Eisai Pharmaceutical, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Novartis, Takeda Pharmaceutical, Abbott Japan Co., Ltd., Astellas Pharma, Ltd., Daiichi Sankyo, Pfizer, Sanofi–Aventis, Santen Pharmaceutical, Teijin Pharma Ltd., Asahikasei Pharma Corp., SymBio Pharmaceuticals Ltd., Celtrion, Nippon Kayaku Co. Ltd., Eli Lilly Japan K.K. and Taisho Toyama Pharmaceutical.