This study presents a comprehensive procedure of synovectomy and synovial biopsies via arthroscopy in the shoulder for an RA patient, as well as the pathological classifications and treatments.
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Method Article
This study presents a comprehensive procedure of synovectomy and synovial biopsies via arthroscopy in the shoulder for an RA patient, as well as the pathological classifications and treatments.
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial hyperplasia and joint destruction. Synovectomy and synovial biopsies are valuable procedures for diagnostic and research purposes. Synovectomy may also provide symptomatic relief in selected cases when medical therapy is insufficient. Arthroscopic-guided techniques offer a minimally invasive approach with enhanced accuracy in tissue sampling. This technique provides the distinct advantage of direct visualization, allowing for targeted biopsy of specific areas within the joint and the collection of tissue, including the crucial lining layer. Significant insights into the pathobiology of RA have been gained through the study of synovium obtained via this method. Moreover, emerging evidence has suggested that synovial tissue retrieved through arthroscopy may facilitate the identification of pathotypes, enabling a more precise, personalized approach to treatment selection for individual patients. Therefore, this paper presents a detailed description of the arthroscopic guided synovectomy in the shoulder and synovial biopsies and identification of pathotypes in a RA patient, drawing on the extensive experience at Renji Hospital.
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation, leading to joint destruction and significant disability1. While advances in disease-modifying antirheumatic drugs (DMARDs) have improved outcomes, up to 30-40% of RA patients failed to respond to individual agents1. Given the heterogeneity in treatment response, there is an increasing need for synovectomy and synovial biopsies in clinical practice to facilitate early diagnosis, guide personalized therapeutic strategies, and improve patient outcomes2.
Synovectomy....
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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, as well as with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For the inclusion and exclusion criteria, refer to Supplementary File 1.
1. Preparation of the patient
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Arthroscopic synovial biopsy was performed in a patient with active shoulder synovitis and systemic inflammatory arthritis. On clinical examination, the shoulder exhibited a limited range of motion and localized tenderness, particularly in the anterior region. Inflammatory markers were elevated (CRP: 24.23 mg/L; ESR: 59 mm/h), while RA-related autoantibodies were negative. The DAS28 score for this patient was 5.81, indicating a high level of disease activity in RA.
Preoperative MRI demonstrate.......
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This paper described a detailed procedure of synovectomy and synovial biopsy in the management of RA, particularly when performed in large joints like the shoulder. Synovectomy may offer symptomatic relief by removing inflamed synovial tissue, particularly in cases of joint-specific, treatment-refractory synovitis. It is typically considered an adjunct to pharmacologic therapy, rather than a primary intervention. Synovectomy is an important procedure for RA patients, particularly in cases where inflammation persists desp.......
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The authors have nothing to disclose.
We thank the participant who made this study possible, and gratefully acknowledge the staff in the department of Rheumatology and Orthopedics, Renji Hospital of Shanghai Jiaotong University School of Medicine.
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| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| 0.9% Sodium Chloride Injection (1000ml) | Baxter | A-WN-014-1 | |
| 10% formalin | Various | Not applicable | |
| 560 surgical imaging system | Smith-Nephew | 93300001 | |
| Αdhesive sterile gauze | Various | Not applicable | |
| Arthroscope (1.9 mm, 30°) | Smith-Nephew | 4184 | |
| Arthroscope (2.7 mm, 30°) | Smith-Nephew | 7205682 | |
| Arthroscope (4 mm, 30°) | Smith-Nephew | 7220287 | |
| Biopsy forceps | Various | Not applicable | |
| Limb position (Spider 2) | Smith-Nephew | 72203299 | |
| Mosquito forceps | Various | Not applicable | |
| Pneumatic toruniquet | Zimmer-Biomet | 60-2200-301-01 | |
| Povidone-iodine | Various | Not applicable | |
| Radiofrequecncy ablation probe | Smith-Nephew | ASC4250-01 | |
| Radiofrequecncy ablation probe(2.3 mm) | Smith-Nephew | AC2823-01 | |
| Radiofrequecncy ablation system | Smith-Nephew | H4500-00 | |
| Scalpel No 11 | Various | Not applicable | |
| Scissors straight 11 cm | Various | Not applicable | |
| Shaver blade (2.0 mm) | Smith-Nephew | 72201507 | |
| Shaver blade (2.9 mm) | Smith-Nephew | 72201509 | |
| Shaver blade (3.5 mm) | Smith-Nephew | 7205306 | |
| Shaver blade (3.5 mm) | Smith-Nephew | 7205345 | |
| Shaver handpiece | Smith-Nephew | 72201500 | |
| Shaver system | Smith-Nephew | 72200873 | |
| Sterile surgical gloves | Various | Not applicable | |
| Suture 4.0 Vicryl | Johnsons | W4993 | |
| Waterproof drape | Various | Not applicable |
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