A total of 93 consecutive biopsy procedures from 57 patients were assessed. The patients were recruited as part of the Pathobiology of Early Arthritis Cohort study. No significant complications were reported after the procedure. Nor were there any significant differences between before and after when it came to pain, swelling and stiffness.2
A median of 14 biopsy samples was obtained from each procedure. And 93% of the procedures yielded quality tissue.
When asked whether they would do it again, the vast majority of the patients said they were either very likely or somewhat likely to agree to it, Dr. Kelly said.
The yield of quality tissue is related to the degree of synovial thickening—with grade 3 giving an excellent yield. Overall, 92.5% of the samples were grade-able, and even those joints with minimal amounts of synovial thickening still had 45% graded biopsies, Dr. Kelly said.
He emphasized how important it is that the procedure be repeatable, so synovial tissue can be retrieved from the same joint at different times for research purposes. They also found that samples can be scanned and used later for comparison because they don’t show changes over time.
Dr. Kelly said a minimum of six samples will generally be representative of a large joint and four for a small joint. Getting that amount requires 8–10 samples, but it’s feasible to acquire 15–20 samples during a biopsy, allowing tissue to be processed for RNA and gene expression when required.
He said those considering the approach need to have a good basis in ultrasound training and need to be doing guided injections.
“I think this is a safe and well-tolerated procedure,” Dr. Kelly said. “Our patients are happy to have it performed repeatedly. You can access small and large joints, and get good quality tissue from histological grading and RNA. It’s reproducible and training certainly seems to be feasible.”
Researchers found that adding a Sjögren’s ultrasound score into the ACR criteria boosted sensitivity to 84%, compared with 64% with ACR alone.
How should ultrasound be applied in Sjögren’s syndrome?
Using ultrasound along with the American College of Rheumatology’s classification criteria for Sjögren’s improves diagnoses, said Sandrine Jousse-Joulin, MD, a rheumatologist in the Ultrasound Unit at La Cavale Branch Hospital in Brest, France.
In a study done earlier this year, researchers at the hospital studied 101 patients with suspected primary Sjögren’s syndrome. The cases in doubt were diagnosed by a blinded panel of experts. The patients had the four major salivary glands assessed by ultrasound.
