Ultrasound guided synovial biopsy - the minimally invasive approach

Until recently, tissue samples from joints were obtained through arthroscopy under direct vision. We have developed a less invasive approach done directly under ultrasound guidance, which minimises the risk of damage to blood vessels or surrounding particular structures.

Under aseptic conditions, local anaesthetic is percutaneously introduced to the joint, followed by a small Quick-core biopsy needle in order obtain samples of tissue from the joint, a technique which has shown to be well tolerated with little discomfort or after-effects. (Kelly et al - in preparation)

What is the role of ultrasound guided biopsy in the R4RA trial?

Biopsies will be performed at baseline, prior to any treatment and at 6 months. The tissue obtained will be sent for both histological grading and for molecular analysis. By correlating these results to clinical responsiveness to each drug, we may be able to in the future predict which particular pathotype is likely to respond to B-cell depletion, and stratify patients accordingly - working towards medicine tailored for the individual.

The R4-RA trial is funded by the MRC-NIHR Efficacy and
Mechanism Evaluation Programme