Synovial Biopsy in the Evaluation of Nonrheumatic Systemic Diseases Causing Arthritis

H. Ralph Schumacher; Lan X. Chen; Frank Pessler

Disclosures

Curr Opin Rheumatol. 2008;20(1):61-65. 

In This Article

Introduction

A variety of systemic diseases not generally considered as rheumatic diseases can involve joints and can create differential diagnostic dilemmas. It is important to consider each of these possibilities because, first, they often have and require specific treatments that can prevent or ameliorate their other systemic manifestations, and second, they may not do well with the nonspecific, often immunosuppressive, therapies used for our more common diseases.

Detailed history and physical examinations may raise the possibility of some initially unsuspected systemic disease. Laboratory tests, including synovial fluid analysis, may provide further support or confirmation. Synovial biopsies are infrequently performed or considered by rheumatologists but may be an underappreciated source of diagnostic help.

In this report, we review potentially helpful synovial findings in a variety of diseases ( Table 1 ). Some may require fairly routine histopathology while others need special techniques. In specific situations, consider special stains, immunohistochemistry, electron microscopy, in-situ hybridization, PCR, or even laser microdissection or microarray analysis.[1,2,3,4,5,6]

Finally, we briefly review methods of obtaining synovial biopsies and assess their advantages/disadvantages.

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