Clinical Applications of Synovial Biopsy

Abstract

The synovial tissue is a primary target of multiple diseases characterized by different pathogenic mechanisms, including infective, deposition, neoplastic, and chronic immune-inflammatory pathologies. Synovial biopsy can have a relevant role in differential diagnosis of specific conditions in clinical practice, although its exploitation remains relatively limited. In particular, no validated synovial-tissue-derived biomarkers are currently available in the clinic to aid in the diagnosis and management in most frequent forms of chronic inflammatory arthropathies, namely rheumatoid arthritis (RA) and the spondyloarthritides (SpA). In this brief review, we will discuss the current spectrum of clinical applications of synovial biopsy in routine rheumatologic care and will provide an analysis of the perspectives for its potential exploitation in patients with chronic inflammatory arthritides.

Keywords: arthritis; biomarkers; precision medicine; synovial biopsy; synovitis.

Figure 1

Multidimensional approach for personalized medicine in arthritis. Different anatomic and functional dimensions can cooperate to delineate the heterogeneous phenotype of chronic inflammatory arthritides and the predisposition of subgroup of patients to respond to specific treatments or to respond to any treatment. Dissecting the synovial histological and molecular characteristics of each individual patient may provide a fundamental contribution to the stratification process by offering a privileged window on the differential expression of the disease at target sites.