Synovial Biopsy:
Most common site: Knee joint. Other joints are shoulder, elbow and wrist joint.
Types of procedure:
1. Blind procedure (needle biopsy) - 14G Parker-Pearson needle
2. Arthroscopy guided
3. USG guided
Indications:
1.Infective: Acute, chronic or tubercular
2. Autoimmune/ Degenerative: Osteoarthritis, Rheumatoid arthritis, ankylosisng spondylitis, psoriatic
3. Crystals: Gout (urate), pseudo gout (CPPD)
4. Metabolic: Ochronosis, Hemochromatosis
5. Infiltrative diseases: Sarcoid, amyloid, pigmented villo-nodular synovitis etc.
Normal synovium:
Lining (intima): Type A and Type B synoviocytes.
Subintima (highly vascular): Mast cells, connective tissue and endothelial cells; collagen.
Synovial markers of disease activity: Intimal layer thickness, blood vessel proliferation and macrophage infiltration.
Interpretations:
1. Neutrophils : Septic arthritis, Behcet's disease, crystal disease
2. Lymphoid follicles, plasma cells: RA, Ankylosing spondylitis, psoriasis, Reiter's disease.
3. Iron deposition: Hemophilic arthopathy, Hemochromatosis, PVNST, hemangioma.
4. Granulomas: TB, Sarcoid, fungal, Crohn's disease.
5. Fragments of bone and cartilage: Osteoarthritis
Complications:
Safe procedure.
Minor complications include: Hemarthrosis (1%), Wound and joint infection (0.1%) and DVT (0.2%)
Most common site: Knee joint. Other joints are shoulder, elbow and wrist joint.
Types of procedure:
1. Blind procedure (needle biopsy) - 14G Parker-Pearson needle
2. Arthroscopy guided
3. USG guided
Indications:
1.Infective: Acute, chronic or tubercular
2. Autoimmune/ Degenerative: Osteoarthritis, Rheumatoid arthritis, ankylosisng spondylitis, psoriatic
3. Crystals: Gout (urate), pseudo gout (CPPD)
4. Metabolic: Ochronosis, Hemochromatosis
5. Infiltrative diseases: Sarcoid, amyloid, pigmented villo-nodular synovitis etc.
Normal synovium:
Lining (intima): Type A and Type B synoviocytes.
Subintima (highly vascular): Mast cells, connective tissue and endothelial cells; collagen.
Synovial markers of disease activity: Intimal layer thickness, blood vessel proliferation and macrophage infiltration.
Interpretations:
1. Neutrophils : Septic arthritis, Behcet's disease, crystal disease
2. Lymphoid follicles, plasma cells: RA, Ankylosing spondylitis, psoriasis, Reiter's disease.
3. Iron deposition: Hemophilic arthopathy, Hemochromatosis, PVNST, hemangioma.
4. Granulomas: TB, Sarcoid, fungal, Crohn's disease.
5. Fragments of bone and cartilage: Osteoarthritis
Complications:
Safe procedure.
Minor complications include: Hemarthrosis (1%), Wound and joint infection (0.1%) and DVT (0.2%)
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