Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department
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To assess the diagnostic value of ultrasound-guided (US-guided) synovial biopsy in routine clinical practice in cases of acute and chronic arthritis. A retrospective, single-center study of US-guided synovial biopsies between 2003 and 2013. The clinical, laboratory, radiographic, synovial fluid, and histological and bacteriological results of synovial biopsies were analyzed. Arthritis was classified according to disease duration < 6 weeks (AA) or ≥ 6 weeks (CA). Synovial biopsy success rate was defined by the rate of capsular and/or synovial tissue analyzed. The diagnostic efficiency was defined by synovial biopsy success rate multiplied by the clinical utility (validation of a diagnostic hypothesis leading to a specific therapy). One hundred seventy-six US-guided synovial biopsies (51 AA and 125 CA) were analyzed. Synovial biopsy success rate was 82.4%. The diagnostic efficiency was 19.9%. Among the acute arthritis cases, 11 were septic. Only three patients had a positive biopsy culture while the synovial fluid puncture was of insufficient quantity to allow bacteriological analysis. The perivascular infiltration of neutrophils (PMN) had a sensitivity of 81.8%, a specificity of 84.2%, and a positive likelihood ratio of 5.2 for the septic arthritis diagnosis. Among the chronic arthritis cases, no case of pyogenic septic arthritis was found. No histological lesions, examined separately, were specific to a type of chronic inflammatory joint disease. US-guided synovial biopsies remain relevant for the diagnosis of septic arthritis, in cases of acute arthritis when joint aspiration is not possible.
KeywordsArthritis Diagnosis Synovial biopsy Ultrasound
All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published.
Dr. Coiffier had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study conception and design. GC, MF, JDA
Acquisition of data. MF, NS, AG
Analysis and interpretation of data. GC, MF, JDA, AP, PG
Compliance with ethical standards
- 1.Wiles NJ, Lunt M, Barrett EM, Bukhari M, Silman AJ, Symmons DP et al (2001) Reduced disability at five years with early treatment of inflammatory polyarthritis: results from a large observational cohort, using propensity models to adjust for disease severity. Arthritis Rheum 44(5):1033–1042CrossRefPubMedGoogle Scholar
- 11.Scirè CA, Epis O, Codullo V, Humby F, Morbini P, Manzo A, Caporali R, Pitzalis C, Montecucco C (2007) 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 9(5):R101CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Kelly S, Humby F, Filer A, Ng N, Di Cicco M, Hands RE et al (2015) Ultrasound-guided synovial biopsy: a safe, well-tolerated and reliable technique for obtaining high-quality synovial tissue from both large and small joints in early arthritis patients. Ann Rheum Dis 74(3):611–617CrossRefPubMedGoogle Scholar
- 32.Krenn V, Perino G, Rüther W, Krenn VT, Huber M, Hügle T, Najm A, Müller S, Boettner F, Pessler F, Waldstein W, Kriegsmann J, Casadonte R, Häupl T, Wienert S, Krukemeyer MG, Sesselmann S, Sunitsch S, Tikhilov R, Morawietz L (2017) 15 years of the histopathological synovitis score, further development and review: a diagnostic score for rheumatology and orthopaedics. Pathol Res Pract 213(8):874–881CrossRefPubMedGoogle Scholar
- 38.Taylor WJ, Fransen J, Dalbeth N, Neogi T, Ralph Schumacher H, Brown M, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Scire CA, Cavagna L, Lin C, Chou YY, Tausche AK, da Rocha Castelar-Pinheiro G, Janssen M, Chen JH, Slot O, Cimmino M, Uhlig T, Jansen TL (2016) Diagnostic arthrocentesis for suspicion of gout is safe and well tolerated. J Rheumatol 43(1):150–153CrossRefPubMedGoogle Scholar