[Ultrasound-guided synovial biopsy]

Area of Science:

• Rheumatology
• Infectious Diseases
• Diagnostic Imaging

Background:

• A 47-year-old female with HIV and hepatitis B presented with recurrent hand arthritis.
• Initial investigations for connective tissue disease and spondyloarthritis were negative, with no systemic inflammation or bony changes.
• Standard treatments provided only temporary relief, necessitating further diagnostic exploration.

Purpose of the Study:

• To investigate the utility of synovial biopsy in diagnosing undifferentiated arthritis.
• To identify the underlying cause of persistent arthritis in an immunocompromised patient.

Main Methods:

• Ultrasound-guided synovial biopsy was performed to obtain tissue samples.
• Dual-energy computed tomography (CT) was used to confirm the presence of urate crystals.
• Standard laboratory tests and radiological assessments were conducted.

Main Results:

• Synovial biopsy revealed gout tophi, indicating the presence of urate crystals.
• Dual-energy CT confirmed urate crystal deposition in the soft tissues.
• Puncture analysis, the gold standard, was not feasible due to the absence of joint effusion.

Conclusions:

• Synovial biopsy is an effective, minimally invasive diagnostic tool for undifferentiated arthritis when conventional methods fail.
• Early diagnosis of gout tophi is crucial for appropriate management, even in patients with coexisting conditions like HIV and hepatitis B.