# Ultrasound-Guided Synovial Biopsy Can Be Effectively and Safely Performed in Different Clinical Settings Favouring a Widespread Application of Precision Medicine in Rheumatoid Arthritis: A Post-hoc Analysis of Three Clinical Trials

## TL;DR

This study shows that ultrasound-guided synovial biopsy can be safely and effectively performed in community hospitals, supporting broader use of precision medicine in rheumatoid arthritis.

## Contribution

The study demonstrates that ultrasound-guided synovial biopsy can be safely performed in non-specialized hospitals, expanding access to precision medicine for rheumatoid arthritis.

## Key findings

- US-SB performed in community hospitals had similar tissue and RNA quality compared to specialized rheumatology centers.
- Adverse events were rare and not severe in either setting.
- Pain was more frequently reported in the community hospital group.

## Abstract

Objectives: In the perspective of an increasingly widespread application of precision medicine in rheumatoid arthritis (RA), this study aimed to compare efficacy and safety of ultrasound-guided synovial biopsy (US-SB) performed in an experienced rheumatology and community hospital setting. Methods: A post hoc analysis of R4RA, STRAP and STRAP-EU trials was performed, comparing US-SB performed in a radiology department of a community hospital without experience in RA (n = 14), versus a rheumatology academic centre with a high expertise in RA management and US-SB (n = 16). Suitability of specimens for histological and transcriptomic analysis (tissue and RNA quality) was analyzed as the main outcome. Results: Demographic and clinical features of the two patients’ groups were similar, except of disease duration (p < 0.05). No differences were recorded regarding site and ultrasound of the biopsied joint. Suitability for histological (% of gradable tissue) and transcriptomic analysis (RIN >3) was similar in the two cohorts (both 85.7% vs. 87.5%, p = 0.88). Proportion of gradable biopsies in total (59.2% vs. 59.5%, p = 0.96) and for each patient (52% vs. 56.15%, p = 0.77), were similar in both cohorts. Adverse events were rare (two in community hospital cohort, one in rheumatology cohort, p = 0.54), none considered severe. Seven patients in the community hospital experienced mild or severe pain, only two referred the same in the rheumatology cohort (p = 0.04). Conclusions: US-SB can be safely and effectively performed in a community hospital without experience in RA. A larger diffusion of this technique could allow to pursuit a tailored approach also in ordinary rheumatology outpatient clinics.