Diagnostic value of blind synovial biopsy in clinical practice

Objective. To assess the diagnostic value of blindly performed synovial biopsies in carefully selected patients with unclassified arthritis. Methods. Synovial tissue was obtained blindly under local anaesthesia. The Arthroforce III take-apart 3.5mm needle and 1.5mm grasping forceps were used for this purpose. Results. Four patients with unclassified arthritis could be diagnosed properly based upon examination of synovial tissue of the knee obtained by an easy-to-perform blind biopsy. The arthritis of the four patients was diagnosed as being part of Erdheim–Chester disease, sarcoidosis, multicentric reticulohistiocytosis and arthritis caused by foreign-body material, respectively. Conclusions. Analysis of synovial tissue obtained during a blind biopsy procedure has diagnostic potential in carefully selected patients with unclassified arthritis. The common denominator in all the cases presented was a differential diagnosis consisting of a rheumatological disease with characteristic histological features. KEY WORDS: Blind biopsy, Synovial membrane, Diagnosis, Histology, Arthritis. Synovial biopsies are seldom used for diagnostic purposes. In general, patient interview, clinical examination, routine laboratory testing, radiographic examination and synovial fluid analysis usually suffice to establish a correct diagnosis. Synovial biopsy analysis is only justified in cases with a high degree of suspicion of atypical infectious agents, evaluation for intra-articular tumours and diseases with characteristic histological features [1, 2]. In these cases, identifying the correct diagnosis is of major importance since it may lead to adjustment of therapy. Biopsies of synovial tissue for diagnostic purpose are usually performed by the use of orthopaedic arthroscopies requiring specially equipped rooms and partial or total anaesthesia, limiting the value of histology of synovial tissue in daily clinical practice [1–4]. The present case series demonstrates that in selected cases a proper diagnosis can be based upon examination of synovial tissue obtained by the use of an easy-to-perform blind biopsy. This procedure led to adjustment of therapy in all the patients presented here