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Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department

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Abstract

To assess the diagnostic value of ultrasound-guided (US-guided) synovial biopsy in routine clinical practice in cases of acute and chronic arthritis. A retrospective, single-center study of US-guided synovial biopsies between 2003 and 2013. The clinical, laboratory, radiographic, synovial fluid, and histological and bacteriological results of synovial biopsies were analyzed. Arthritis was classified according to disease duration < 6 weeks (AA) or ≥ 6 weeks (CA). Synovial biopsy success rate was defined by the rate of capsular and/or synovial tissue analyzed. The diagnostic efficiency was defined by synovial biopsy success rate multiplied by the clinical utility (validation of a diagnostic hypothesis leading to a specific therapy). One hundred seventy-six US-guided synovial biopsies (51 AA and 125 CA) were analyzed. Synovial biopsy success rate was 82.4%. The diagnostic efficiency was 19.9%. Among the acute arthritis cases, 11 were septic. Only three patients had a positive biopsy culture while the synovial fluid puncture was of insufficient quantity to allow bacteriological analysis. The perivascular infiltration of neutrophils (PMN) had a sensitivity of 81.8%, a specificity of 84.2%, and a positive likelihood ratio of 5.2 for the septic arthritis diagnosis. Among the chronic arthritis cases, no case of pyogenic septic arthritis was found. No histological lesions, examined separately, were specific to a type of chronic inflammatory joint disease. US-guided synovial biopsies remain relevant for the diagnosis of septic arthritis, in cases of acute arthritis when joint aspiration is not possible.

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Author information

Authors and Affiliations

  1. Rheumatology Department, Rennes University Hospital - Hôpital Sud, 16 boulevard de Bulgarie, BP90347, 35203, Rennes Cedex 2, France

    Guillaume Coiffier, Jean-David Albert, Aleth Perdriger & Pascal Guggenbuhl

  2. INSERM 1241, Rennes 1 University, Rennes, France

    Guillaume Coiffier, Jean-David Albert, Anne Jolivet-Gougeon & Pascal Guggenbuhl

  3. Rheumatology Department, Vannes Hospital, Hôpital Chubert, 20 Boulevard Général Maurice Guillaudot, 56000, Vannes, France

    Marine Ferreyra

  4. Pathology Department, Rennes University Hospital – Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France

    Nathalie Stock

  5. Bacteriology Laboratory, Rennes University Hospital – Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France

    Anne Jolivet-Gougeon

Authors
  1. Guillaume Coiffier
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  2. Marine Ferreyra
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  3. Jean-David Albert
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  4. Nathalie Stock
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  6. Aleth Perdriger
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  7. Pascal Guggenbuhl
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Contributions

All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published.

Dr. Coiffier had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study conception and design. GC, MF, JDA

Acquisition of data. MF, NS, AG

Analysis and interpretation of data. GC, MF, JDA, AP, PG

Corresponding author

Correspondence to Guillaume Coiffier.

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Highlights

• A total of 82.4% of US-guided synovial biopsies were able to analyze capsular and/or synovial tissue.

• US-guided synovial biopsies seem to be useful for the diagnosis of septic arthritis when joint aspiration is not possible or in the absence of synovial fluid.

• The perivascular infiltration of neutrophils had a positive likelihood ratio of 5.2 to the pyogenic septic arthritis.

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Coiffier, G., Ferreyra, M., Albert, JD. et al. Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department. Clin Rheumatol 37, 2241–2249 (2018). https://doi.org/10.1007/s10067-018-4160-9

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  • DOI: https://doi.org/10.1007/s10067-018-4160-9

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