Arthroscopic Guided Synovectomy, Synovial Biopsies, and Pathotype Identification in Refractory Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial hyperplasia and joint destruction. Synovectomy and synovial biopsies are valuable procedures for diagnostic and research purposes. Synovectomy may also provide symptomatic relief in selected cases when medical therapy is insufficient. Arthroscopic-guided techniques offer a minimally invasive approach with enhanced accuracy in tissue sampling. This technique provides the distinct advantage of direct visualization, allowing for targeted biopsy of specific areas within the joint and the collection of tissue, including the crucial lining layer. Significant insights into the pathobiology of RA have been gained through the study of synovium obtained via this method. Moreover, emerging evidence has suggested that synovial tissue retrieved through arthroscopy may facilitate the identification of pathotypes, enabling a more precise, personalized approach to treatment selection for individual patients. Therefore, this paper presents a detailed description of the arthroscopic guided synovectomy in the shoulder and synovial biopsies and identification of pathotypes in a RA patient, drawing on the extensive experience at Renji Hospital.