OP0278-HPR Patient reported outcomes and safety in patients undergoing synovial biopsy: comparison of arthroscopic, ultrasound-guided portal-forceps and ultrasound-guided needle biopsy techniques, in five centres across europe
Authors: S.A. Just, F. Humby, H. Lindegaard, L. Meric de Bellefon, P. Durez, E. Vieira-Sousa, R. Teixeira, M. Stoenoiu, J. Werlinrud, S. Rosmark, P.V. Larsen, C. Pitzalis, A. Filer
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Synovial tissue analysis could provide a step towards personalised medicine in daily clinical practice for patients with inflammatory arthritis. However systematic reports comparing the patient's perspective when undergoing synovial biopsy according to different synovial sampling techniques is currently missing from the literature. We here present a multicenter study across Europe, comparing patient reported outcomes (PRO) and safety data from patients undergoing synovial biopsy procedures using either ultrasound guided needle biopsy (US-NB), ultrasound guided portal and forceps (US-PF) or conventional arthroscopy. <h3>Objectives</h3> 1. Describe PRO data on joint indices of pain, stiffness and swelling, procedural discomfort and willingness to undergo a second biopsy for each biopsy technique. 2. Describe and compare safety data. 3. Evaluate the impact of intramuscular (IM) or intra-articular (IA) corticosteroid as part of the biopsy procedure, on PRO data and safety. 4. Evaluate how sequential biopsy procedures impacted on PRO and safety data. <h3>Methods</h3> Information on PROs, safety, diagnosis, disease activity and treatment were collected from five European biopsy centres. Joint pain, swelling and stiffness indices were recorded as 0–100 mm VAS; qualitative variables on balanced 5-point Likert scales. PRO data delta values between post and pre-values were calculated. Between group comparisons with unadjusted and adjusted robust linear regression, adjusting for disease activity, corticosteroid use during biopsy procedure and when relevant pre-biopsy value. <h3>Results</h3> 524 synovial biopsy procedures were included; 329 (78%) had Rheumatoid Arthritis and biopsies were primarily from wrist (n=296, 57%). PRO and safety data are presented in table 1. None of the biopsy techniques caused increase in pain, swelling or stiffness, and there were no differences in post biopsy and delta PROs between biopsy procedures. There was 9 adverse events (1.7%) with no difference between biopsy methods(p=0.85). 71.7% reported none or mild discomfort during biopsy and 86.5% were positive or neutral to rebiopsy. Corticosteroid use, IM (n=62) or IA (n=38), did not result in more adverese events (p=0.81). However, it was associated with a reduction in post-swelling (p=0.005), but not pain or stiffness. Sequential biopsy procedures (n=103 patients), did not result in more adverse events (p=0.61) or worsening in PRO data between baseline and second biopsy procedure. <h3>Conclusions</h3> Overall, our results do not suggest a significant difference in tolerability or safety between US-NB, US-PF or arthroscopic synovial sampling. Further, data suggests that use of IM or IA corticosteroid, as part of the biopsy procedure, is safe and improves tolerability. Finally, sequential synovial biopsies were well tolerated and safe when performed using all biopsy techniques. <h3>Disclosure of Interest</h3> None declared