title: Ultrasound-guided synovial biopsy of the wrist does not alter subsequent clinical or ultrasound disease activity assessments: a prospective study for incorporation of imaging in clinical trials.
abstract: OBJECTIVE
  Ultrasound-guided synovial biopsy (UGSB) is a minimally-invasive procedure capable of retrieving good quality tissue from small and large joints. The use of UGSB in prospective clinical trials poses a dilemma as to whether biopsied joints may be later included in core data sets for clinical or imagining response, as the procedure itself may alter disease activity assessment. In this study, we examine the impact of UGSB of the wrist on subsequent clinical and ultrasound (US) assessments in a cohort of rheumatoid arthritis (RA) patients prior to initiation of anti-TNF-alpha therapy.
  
  
  METHODS
  Patients had active disease (DAS>5.1) involving their wrist. Both wrists were scanned and the most inflamed one underwent an UGSB. Ultrasonographic and clinical assessments were repeated at the patients' subsequent visit, without any changes in disease-modifying treatment between visits. US images were scored semi-quantitatively and quantitatively for synovial thickness (ST) and power Doppler (PD). Mixed-effects model and paired-Wilcoxon signed rank test were used to assess the effect of UGSB on these scores.
  
  
  RESULTS
  Twenty-nine patients were enrolled. No significant difference in mean ST (p=0.32) or PD (p=0.21) was demonstrated pre- and post-biopsy (mean time 14.7 days). Similar results were obtained using quantitative measures. The DAS-28 and its components did not change significantly post-biopsy.
  
  
  CONCLUSIONS
  In this population, UGSB of the wrist did not significantly alter subsequent clinical or US assessments, indicating that a wrist joint, which has undergone UGSB, may be incorporated into an US dataset or clinical outcome assessment tools, such as the DAS-28, without prejudice.
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Ilias
authors.initials: I
authors.lastname: Lazarou
authors.affiliation: Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK. stephen.kelly@bartshealth.nhs.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kelly
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Humby
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Cicco
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Lu
authors.initials: L
authors.lastname: Zou
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Vidalba
authors.initials: V
authors.lastname: Rocher-Ros
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Rebecca Eve
authors.initials: RE
authors.lastname: Hands
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Nora
authors.initials: N
authors.lastname: Ng
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Arti
authors.initials: A
authors.lastname: Mahto
authors.affiliation: Experimental Medicine and Rheumatology, Queen Mary University of London, William Harvey Research Institute, London, UK.
authors.forename: Costantino
authors.initials: C
authors.lastname: Pitzalis
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009339:Needles; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology*; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents