Ultrasound-guided biopsy from hand joints in arthralgia or arthritis patients: a feasibility study

The mechanisms underlying arthritis becoming chronic are poorly understood. The
development of rheumatoid arthritis (RA) is considered to be a multiple-hit
process that is largely taking place before the disease presents with
clinically swollen joints. The disease is characterised by inflammation of
synovium, preferentially the joints of the hands. Research, from our own
department using MRI, showed that RA is also characterized by inflammation of
the tenosynovium, as tenosynovitis is present in >85% of RA-patients at the
time of diagnosis. Furthermore tenosynovitis is one of the first features of
developing RA. Tissue research has so far focussed on synovitis, using
established molecular techniques on biopsies from patients with established
disease. Ultrasound (US)-guided synovial biopsy techniques have been developed,
also for hand joints, and proved reliable, minimally invasive, well-tolerated
and safe when grade 2 inflammation is present. Whilst established molecular
techniques require relatively large tissue samples, novel techniques have
developed, such a single cell sequencing and imaging mass cytometry, which
provide unprecedented possibilities to discover (novel) cells characterizing
disease and require only small tissue fragments. This would allow to perform
molecular studies of synovitis and tenosynovitis from hand joints in patients
in early phases of RA. Other European groups performing US-guided biopsies,
showed that sufficient material for analyses could be obtained in ~60-90% of
patients biopsied, and that this material was representative of the joint
status in small joints of RA-patients. We aim to determine if it is feasible in
our center to perform US-guided synovitis and tenosynovitis biopsies in the
metacarpophalangeal (MCP)- or wrist joints with grade 2 inflammation and
analysis the obtained tissues. If successful we aim to expand the study in
patients with early stages of RA to enhance our understanding of
RA-pathogenesis and promote subsequent development of targeted therapies

To determine the feasibility of performing US-guided synovitis and
tenosynovitis in wrist and MCP-joints, and investigate the quality and quantity
of the obtained tissues.

This is a cross-sectional observational study.

Patients will have US-guided biopsy. Patients will have no benefits when
participating in this study. Results, which are molecular analyses of
(teno)synovium tissue, will not be communicated to rheumatologists or patients.