Key Points
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Synovial tissue is the target tissue for autoimmune arthritides such as rheumatoid arthritis.
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Synovial biopsy is a safe and well-tolerated procedure that is becoming more widely available.
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There is a significant body of work from the past 30 years analysing the cellular and molecular changes in synovial tissue from patients with rheumatoid arthritis to identify specific biomarkers.
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Technological advances in molecular and cellular analysis now provide new opportunities for defining new biomarkers and targets.
Abstract
The synovium is the major target tissue of inflammatory arthritides such as rheumatoid arthritis. The study of synovial tissue has advanced considerably throughout the past few decades from arthroplasty and blind needle biopsy to the use of arthroscopic and ultrasonographic technologies that enable easier visualization and improve the reliability of synovial biopsies. Rapid progress has been made in using synovial tissue to study disease pathogenesis, to stratify patients, to discover biomarkers and novel targets, and to validate therapies, and this progress has been facilitated by increasingly diverse and sophisticated analytical and technological approaches. In this Review, we describe these approaches, and summarize how their use in synovial tissue research has improved our understanding of rheumatoid arthritis and identified candidate biomarkers that could be used in disease diagnosis and stratification, as well as in predicting disease course and treatment response.
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Change history
19 December 2017
In the version of this article originally published, the author Sander W. Tas was erroneously omitted from the author list. This error has now been corrected in the online version of the article.
22 September 2017
In the original version of this article the name of one of the authors, Elsa Vieira-Sousa, was incorrectly given as Elsa Sousa. This error has now been corrected in the PDF and HTML versions of the article.
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Acknowledgements
We wish to thank all our colleagues in the European Synovitis Study Group and in the OMERACT group who have supported the development of synovial tissue research.
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D.J.V., C.O., U.F., A.N., A.P., S.W.T. and J.E.F. researched data for the article, made a substantial contribution to the discussion of article content, wrote the manuscript, and reviewed and edited the manuscript before submission. E.V.-S., F.H., S.A.J., T. McG. and R.T. researched data for the article, wrote the manuscript, and reviewed and edited the manuscript before submission. A.F. researched data for the article, and reviewed and edited the manuscript before submission. B.R.L. wrote the manuscript, and reviewed and edited the manuscript before submission. D.L.B., M.H.B., C.D.B., J.D.C., A.I.C., E.H.C., P.E., D.G., J.D.I., B.L., A.M., I.B.M., C.P., M.S. and P.P.T. reviewed and edited the manuscript before submission.
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Glossary
- Fibroblast-like synoviocytes
-
(FLSs). Also known as type B synovial lining cells, FLSs account for the majority of cells in the synovial lining layer.
- Intimal lining layer
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The lining of the synovium comprising a few cells without a basement membrane and which covers the nonarticular surface of the joint capsule.
- Synovial sublining
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A loose connective tissue that lies beneath the intimal lining of the synovium.
- Pannus
-
A 'tumour-like' mass of hyperplastic synovial tissue that expands into the joint, invading into bone and cartilage.
- Arthroplasty
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Surgical reconstruction or replacement of a synovial joint.
- Arthroscopic biopsy
-
Minimally invasive procedure to examine a synovial joint using an endoscope.
- Ex-TH17 cells
-
T helper 17 (TH17) cells can switch to become ex-TH17 cells that no longer produce IL-17 but have the ability to produce IFNγ.
- Positional memory
-
Cells might demonstrate different DNA 'fingerprints' depending on the site of the body at which they reside.
- Undifferentiated arthritis
-
Inflammatory oligoarthritis or polyarthritis that does not conform to any of the recognized inflammatory arthritis types.
- Disease stratification
-
The concept that a disease can be classified into distinct subsets that exhibit differential outcomes and responses, and that can each be labelled by a biomarker or a combination of biomarkers.
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Orr, C., Vieira-Sousa, E., Boyle, D. et al. Synovial tissue research: a state-of-the-art review. Nat Rev Rheumatol 13, 463–475 (2017). https://doi.org/10.1038/nrrheum.2017.115
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DOI: https://doi.org/10.1038/nrrheum.2017.115
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