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J Clin Rheumatol. 2019 Jan 18. doi: 10.1097/RHU.0000000000000993. [Epub ahead of print]

Synovial Biopsy in the Diagnosis of Crystal-Associated Arthropathies.

Author information

1
From the Division of Rheumatology and Clinical Immunology, Department of Medicine, and.
2
Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL.
3
Department of Pathology and.
4
Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

Abstract

BACKGROUND/ OBJECTIVE:

This study seeks to assess the utility of synovial biopsy in the diagnosis of crystal-associated arthropathies (CAAs) in a clinical setting.

METHODS:

In this retrospective study, we reviewed biopsy reports involving synovial tissue between 1988 and 2015. We then reviewed the records of patients where the biopsy was performed for a clinical suspicion of CAA-the clinical group-and calculated the frequency of a positive diagnosis. The t test, Mann-Whitney-Wilcoxon test, and Fisher test were used to compare clinical characteristics of patients with and without a tissue diagnosis of CAA. We also reviewed cases of unexpected detection of crystalline disease involving synovial tissue-the incidental group.

RESULTS:

Among 2786 biopsies involving the synovium, we identified 65 cases in the clinical group and 33 cases in the incidental group. In the clinical group, a relevant diagnosis was obtained from synovial tissue in 36.9%, and a CAA was diagnosed in 20%. Restricting analysis to clinical biopsies performed for a primary suspicion of CAA, a relevant diagnosis was obtained in 61.3%, and a CAA was diagnosed in 38.7%. The incidental group comprised 1.2% of all synovial biopsies and included 7 mass lesions. Basic calcium phosphate was not reported on any biopsy in the study period.

CONCLUSIONS:

Synovial biopsy is a diagnostic option when suspected CAA is resistant to conventional modes of diagnosis. Crystalline diseases should be considered in the differential diagnosis of musculoskeletal mass lesions mimicking neoplasms.

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