Synovial Biopsy Findings among Patients with Monoarthritis

Myeong Shin Ryu; Min Young Lee; Chan Woo Lee; Kyu Tae Park; Eun Ji Kim; Young Il Seo; Hyun Ah Kim

doi:10.4078/jrd.2011.18.3.175

Journal List > J Rheum Dis > v.18(3) > 1063907

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Ryu, Lee, Lee, Park, Kim, Seo, and Kim: Synovial Biopsy Findings among Patients with Monoarthritis

Original Article

J Rheum Dis 2011;18(3):175-180.

Published online: 31 September 2011

DOI: https://doi.org/10.4078/jrd.2011.18.3.175

Synovial Biopsy Findings among Patients with Monoarthritis

Myeong Shin Ryu¹, Min Young Lee¹, Chan Woo Lee¹, Kyu Tae Park¹, Eun Ji Kim², Young Il Seo², Hyun Ah Kim²

¹Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea

²Hallym University Sacred Heart Hospital, Anyang, Korea

Received 12 October 201028 October 2010 Accepted 28 October 2010

Abstract

Objective

Any joint disorders can present as monoarthritis initially, which makes the range of differential diagnosis of monoarthritis extensive. Synovial biopsy may play a role in the diagnosis of monoarthritis. We reviewed the synovial biopsy findings of monoarthritis patients in order to assess its diagnostic value.

Methods

Synovial pathologic findings of 39 patients who visited the rheumatology or orthopedic surgery clinic for acute or chronic monoarthritis from Feb., 2006 to Jul., 2010 were reviewed retrospectively.

Result

Four (10.3%) of 39 patients could be diagnosed with specific arthritis after synovial biopsy (rheumatoid arthritis, tuberculous arthritis, giant cell tumor, and os-teochondroma, each).

Conclusion

The result showed that the synovial biopsy is useful for differential diagnosis of monoarthritis in a lim-ited number of cases.

Keywords: Arthritis, Synovium, Pathology, Biopsy

References

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Figure 1.

Multiple periarticular bone erosions and sclerosis with decreased joint space are noted in the elbow joint with effusion and periarticular soft tissue swelling. It was considerd in the differential diagnosis of rheumatoid arthritis, tuberculous arthritis, and septic arthritis.

Figure 2.

Whole body bone scan of the patient who diagnosed as rheumatoid arthritis. Intense increased bone uptake in right wirst and left elbow, suggesting severe arthritis or septic arthritis.

Figure 3.

Tuberculous arthritis of the Rt. 5th PIP joint. Radiograph demonstrated soft tissue swelling of 5 ^th finger. And enchondroma was shown at second proximal phalanx.

Table 1.

Baseline characteristics (N=39)

	Number (%)
Female	19 (48.7)
Age (years, mean± SD)	48.2±20.9
Comorbidity
DM	5 (12.8)
HTN	9 (23.1)
CVA	2 (5.1)
Duration of synovitis (months, mean± SD)	19.8±60.1
Mode
Spontaneous	25 (64.1)
Trauma	12 (30.8)
Postoperation	2 (5.1)
Location
Knee	26 (66.7)
Elbow	2 (5.1)
Ankle	3 (7.7)
Wrist	4 (10.3)
PIP	4 (10.3)
Biopsies
Arthroscopic	35 (89.7)
Needle	4 (10.3)

DM: diabetes mellitus, HTN: hypertension, CVA: cerebrovascula accident, PIP: proximal interphalangeal joint.

Table 2.

Characteristics of synovial pathologies

	Pathologic findings	Mode
F/67	Chronic inflammation, mild with foreign body reaction	Spont
F/81	Consistent with rheumatoid arthritis	Spont
F/14	Chronic inflammation, mild	Trauma
F/75	Chronic inflammation, mild	Spont
M/52	Chronic inflammation, mild	Spont
M/25	Hemorrhage with fibrin clot formation	Spont
F/46	Myxoid degeneration, focal	Spont
F/53	Chronic inflammation, mild with fibrosis	Spont
F/32	Active chronic inflammation, mild	Spont
M/29	Chronic inflammation, mild with dystrophic calcification	Trauma
F/36	Congestion	Trauma
F/80	Congestion	Spont
F/37	Chronic inflammation, minimal	Spont
F/53	No diagnostic abnormalities	Spont
F/61	Chronic inflammation, mild	Spont
M/26	Synovium with degeneration and necrosis	Postop.
M/20	Benign osteocartilagenous tissue, clinically injured	Trauma
M/19	Fatty proliferation	Trauma
M/41	Synovial tissue with fibrinoid tissue	Spont
F/70	Osteocartilagenous tissue, suggestive of synovial osteochondromatosis	Spont
F/73	Chronic inflammation, proliferation of adipocytes	Spont
M/67	Fibrous tissue, unremarkable	Spont
F/44	Giant cell tumor of tendon sheath, localized type	Spont
F/80	Chronic inflammation, mild	Spont
M/70	Tuberculosis	Spont
F/26	Chronic inflammation, marked	Spont
M/39	Chronic inflammation, mild	Trauma
F/74	Chronic synovitis	Spont
M/56	Mild chronic inflammation	Postop.
M/14	Chronic inflammation with fibrinoid necrotic material	Trauma
M/61	Chronic inflammation, mild	Spont
M/18	Chronic inflammation	Trauma
F/43	Synovial tissue with a few lymphocytic infiltration	Spont
M/44	Chronic inflammation	Trauma
M/57	Chronic inflammation, mild	Trauma
M/54	Chronic synovitis	Trauma
M/49	Chronic active inflammation and granulomatous inflammation	Spont
M/18	Fibroadipose tissue with minimal fibrosis	Trauma
M/76	Collagen-like material deposition, congo-red negative	Spont

F: female, M: male, Spont: spontaneous, Postop.: postoperative

Table 3.

Comparisons between the diagnosed group and th undiagnosed group

	Diagnosed	Undiagnosed	p-value^∗
Duration of synovitis (months, mean± SD)	8.2±11.1	21.1±63.3	0.690
ESR (mm/hr, mean± SD)	26.5±34.4	10.4±14.3	0.419
CRP (mg/L, mean± SD)	24.7±22.8	6.5±8.9	0.207
Techniques
Arthroscopic	3 (8.6)	32 (91.4)	0.305
Needle	1 (25)	3 (75)
Mode
Spont	4 (16)	21 (84)	0.287
Trauma	0	12 (100)
Postop.	0	2 (100)

By t-test and Chi-square. ESR: erythrocyte sedimentation rat CRP: C-reactive protein. Data are expressed as number (%) un less specified otherwise. spont: spontaneous, postop.: postope rative.

^∗ p<0.05 is significant.

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