Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis
Abstract Background Undifferentiated arthritis is a condition in which the problem cannot be classified into any definite diagnosis category. Various methods have been suggested to clarify the definite diagnosis in this class. The synovial biopsy is suggested as the last diagnostic approach to deter...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-023-06138-x |
| _version_ | 1828063919623634944 |
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| author | Soosan G Soroosh Ali Ghatfan Abolfazl Farbod Elahe Meftah |
| author_facet | Soosan G Soroosh Ali Ghatfan Abolfazl Farbod Elahe Meftah |
| author_sort | Soosan G Soroosh |
| collection | DOAJ |
| description | Abstract Background Undifferentiated arthritis is a condition in which the problem cannot be classified into any definite diagnosis category. Various methods have been suggested to clarify the definite diagnosis in this class. The synovial biopsy is suggested as the last diagnostic approach to determine the precise histopathological diagnosis. In this study, we aimed to evaluate the efficacy of synovial biopsy for establishing a definite diagnosis in patients with undifferentiated chronic knee monoarthritis. Methods The present retrospective case series was conducted in 2005 in the rheumatology research center of Shariati hospital and the 501 hospital in Tehran, Iran. The study included the synovial biopsy of patients with chronic knee monoarthritis who did not have a definite diagnosis after all the diagnostic steps before the synovial biopsy. Pathology slides of the patients’ synovial biopsy were reevaluated with a senior expert pathologist. Results Eighty patients with a mean age of 37.6 ± 17.32 years (range: 6–68) were included, of whom 50% were female. The gap time between the onset of knee monoarthritis and the decision-making for synovial biopsy was 14.34 ± 19.61 months. Histopathologic evaluations revealed non-specific synovitis in 65% of the patients and a definite diagnosis in 35%. The most common definite diagnosis was rheumatoid arthritis (9%), followed by septic arthritis (5%). The most common pathologic findings were endothelial proliferation (89%) and synovial proliferation (88%), and the most common infiltrating cell was lymphocyte (54%). Patients with non-specific synovitis were more likely to have neovascularization, cellular infiltration (p-value < 0.001), synovial proliferation, endothelial proliferation (p-value = 0.001), pannus formation (p-value = 0.009), and fibrosis (p-value = 0.022) compared to the patients with a definite pathologic diagnosis. However, age, gender, and the gap time between disease symptoms to synovial biopsy were not significantly different between the different groups of diagnosis (p-value > 0.05). Conclusion Non-specific synovitis remains the most common histopathologic finding, highlighting the importance of physician expert opinion for most of the patients with undifferentiated chronic knee monoarthritis. Studies with larger samples and immunohistochemistry analyses are needed to clarify this uncategorized entity further. |
| first_indexed | 2024-04-10T22:50:39Z |
| format | Article |
| id | doaj.art-9ccfa49d27194f319159cfbe14972bee |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-10T22:50:39Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-9ccfa49d27194f319159cfbe14972bee2023-01-15T12:02:17ZengBMCBMC Musculoskeletal Disorders1471-24742023-01-012411710.1186/s12891-023-06138-xSynovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritisSoosan G Soroosh0Ali Ghatfan1Abolfazl Farbod2Elahe Meftah3Rheumatology Research Center, AJA University of Medical Sciences501 Hospital, AJA University of Medical SciencesHeadache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical SciencesStudents’ Scientific Research Center, Tehran University of Medical SciencesAbstract Background Undifferentiated arthritis is a condition in which the problem cannot be classified into any definite diagnosis category. Various methods have been suggested to clarify the definite diagnosis in this class. The synovial biopsy is suggested as the last diagnostic approach to determine the precise histopathological diagnosis. In this study, we aimed to evaluate the efficacy of synovial biopsy for establishing a definite diagnosis in patients with undifferentiated chronic knee monoarthritis. Methods The present retrospective case series was conducted in 2005 in the rheumatology research center of Shariati hospital and the 501 hospital in Tehran, Iran. The study included the synovial biopsy of patients with chronic knee monoarthritis who did not have a definite diagnosis after all the diagnostic steps before the synovial biopsy. Pathology slides of the patients’ synovial biopsy were reevaluated with a senior expert pathologist. Results Eighty patients with a mean age of 37.6 ± 17.32 years (range: 6–68) were included, of whom 50% were female. The gap time between the onset of knee monoarthritis and the decision-making for synovial biopsy was 14.34 ± 19.61 months. Histopathologic evaluations revealed non-specific synovitis in 65% of the patients and a definite diagnosis in 35%. The most common definite diagnosis was rheumatoid arthritis (9%), followed by septic arthritis (5%). The most common pathologic findings were endothelial proliferation (89%) and synovial proliferation (88%), and the most common infiltrating cell was lymphocyte (54%). Patients with non-specific synovitis were more likely to have neovascularization, cellular infiltration (p-value < 0.001), synovial proliferation, endothelial proliferation (p-value = 0.001), pannus formation (p-value = 0.009), and fibrosis (p-value = 0.022) compared to the patients with a definite pathologic diagnosis. However, age, gender, and the gap time between disease symptoms to synovial biopsy were not significantly different between the different groups of diagnosis (p-value > 0.05). Conclusion Non-specific synovitis remains the most common histopathologic finding, highlighting the importance of physician expert opinion for most of the patients with undifferentiated chronic knee monoarthritis. Studies with larger samples and immunohistochemistry analyses are needed to clarify this uncategorized entity further.https://doi.org/10.1186/s12891-023-06138-xKnee monoarthritisSynovial biopsymonoarthropathyChronic synovitisUndifferentiated arthritisMonoarticular arthritis |
| spellingShingle | Soosan G Soroosh Ali Ghatfan Abolfazl Farbod Elahe Meftah Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis BMC Musculoskeletal Disorders Knee monoarthritis Synovial biopsy monoarthropathy Chronic synovitis Undifferentiated arthritis Monoarticular arthritis |
| title | Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis |
| title_full | Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis |
| title_fullStr | Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis |
| title_full_unstemmed | Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis |
| title_short | Synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis |
| title_sort | synovial biopsy for establishing a definite diagnosis in undifferentiated chronic knee monoarthritis |
| topic | Knee monoarthritis Synovial biopsy monoarthropathy Chronic synovitis Undifferentiated arthritis Monoarticular arthritis |
| url | https://doi.org/10.1186/s12891-023-06138-x |
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