{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:37:36Z","timestamp":1784547456026,"version":"3.55.0"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T00:00:00Z","timestamp":1707782400000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"PARTNER Fellowship Program"},{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["GR-2018-12366992"],"award-info":[{"award-number":["GR-2018-12366992"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2024,1,25]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To develop an intensive training programme for ultrasound (US)-guided synovial tissue (ST) biopsy on knees and wrists in inflammatory arthritis and to assess the learning curve, patient tolerability, sample quality and trainees\u2019 expectations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Active or remission rheumatoid arthritis patients were enrolled. Nine trainees joined the 4-month programme in a centre experienced in performing US-guided ST biopsies consisting of four sequential phases: (1) observation, (2) performance of guided step-by-step phases, (3) execution of the whole procedure on paired joints (knees or wrists) of the same patient in parallel with the trainer and (4) performance of the procedure autonomously. Sample representativity was assessed by histology, and procedure-related adverse events were recorded. Before and after the programme, trainees\u2019 expectations and perceptions were collected.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>328 ST biopsy procedures were included. The rate of trainees\u2019 informative samples was: (1) comparable to the trainers in active and remission knees, but lower in active wrists (70% for trainees vs 100% for trainers, p=0.06) in phase 3; (2) excellent on active knees and wrists (91.9% and 90.9% respectively) but lower (77.6%, p=0.0089) on remission knees in phase 4. Procedures performed by trainees did not affect patient tolerability. Trainees\u2019 expectations about procedure-related invasiveness and pain infliction decreased while the difficulty of procedure execution on active wrists and remission knees remained perceived as moderately difficult.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This intensive training programme develops advanced skills in the performance of US-guided ST biopsy on knees and wrists, yielding high-quality specimens available for basic and translational studies on inflammatory joint diseases.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003705","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T22:30:37Z","timestamp":1707863437000},"page":"e003705","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Intensive training programme for ultrasound-guided minimally invasive synovial tissue biopsy on knees and wrists in different phases of inflammation"],"prefix":"10.1136","volume":"10","author":[{"given":"Lavinia Agra","family":"Coletto","sequence":"first","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology - Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natacha","family":"Goulas","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology - Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Rubortone","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology - Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucrezia","family":"Verardi","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology - Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Gaggiano","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Bruno","sequence":"additional","affiliation":[{"name":"Clinical Immunology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"D\u2019Antonio","sequence":"additional","affiliation":[{"name":"Rheumatology, Allergology and Clinical Immunology - Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Gessi","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Di Mario","sequence":"additional","affiliation":[{"name":"Immunology Research Core Facility - Gemelli Science and Technology Park (GSTeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Tolusso","sequence":"additional","affiliation":[{"name":"Immunology Research Core Facility - Gemelli Science and Technology Park (GSTeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bui","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Benvenuto","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1343-1729","authenticated-orcid":false,"given":"Maria Sole","family":"Chimenti","sequence":"additional","affiliation":[{"name":"Rheumatology, Allergology and Clinical Immunology - Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2479-6958","authenticated-orcid":false,"given":"Giuliana","family":"Guggino","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Childcare, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ciccia","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Caporali","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy"},{"name":"Gaetano Pini-CTO, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Gremese","sequence":"additional","affiliation":[{"name":"Clinical Immunology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Immunology Research Core Facility - Gemelli Science and Technology Park (GSTeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Maria","family":"Lizzio","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5347-0060","authenticated-orcid":false,"given":"Maria-Antonietta","family":"D\u2019Agostino","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology - Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Rome, Italy"},{"name":"Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7383-4212","authenticated-orcid":false,"given":"Stefano","family":"Alivernini","sequence":"additional","affiliation":[{"name":"Department of Aging Diseases, Orthopedic and Rheumatology - Division of Rheumatology, Universit\u00e0 Cattolica del Sacro Cuore Facolt\u00e0 di Medicina e Chirurgia, Rome, Italy"},{"name":"Immunology Research Core Facility - Gemelli Science and Technology Park (GSTeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Division of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,13]]},"reference":[{"key":"2025090313362695000_10.1.e003705.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2022.11.009"},{"key":"2025090313362695000_10.1.e003705.2","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1038\/nrrheum.2017.115","article-title":"Synovial tissue research: a state-of-the-art review","volume":"13","author":"Orr","year":"2017","journal-title":"Nat Rev Rheumatol"},{"key":"2025090313362695000_10.1.e003705.3","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S0140-6736(20)32341-2","article-title":"Rituximab versus tocilizumab in anti-TNF inadequate responder patients with rheumatoid arthritis (R4RA): 16-week outcomes of a stratified, biopsy-driven, multicentre, open-label, phase 4 randomised controlled trial","volume":"397","author":"Humby","year":"2021","journal-title":"The Lancet"},{"key":"2025090313362695000_10.1.e003705.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210424"},{"key":"2025090313362695000_10.1.e003705.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-016-0927-z","article-title":"Tapering and discontinuation of TNF-\u03b1 blockers without disease relapse using ultrasonography as a tool to identify patients with rheumatoid arthritis in clinical and histological remission","volume":"18","author":"Alivernini","year":"2016","journal-title":"Arthritis Res Ther"},{"key":"2025090313362695000_10.1.e003705.6","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1007\/s10067-020-05512-7","article-title":"Synovial biopsies in clinical practice and research: current developments and perspectives","volume":"40","author":"Johnsson","year":"2021","journal-title":"Clin Rheumatol"},{"key":"2025090313362695000_10.1.e003705.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204603"},{"key":"2025090313362695000_10.1.e003705.8","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2018-000799","article-title":"Patient-reported outcomes and safety in patients undergoing synovial biopsy: comparison of ultrasound-guided needle biopsy, ultrasound-guided portal and forceps and arthroscopic-guided synovial biopsy techniques in five centres across Europe","volume":"4","author":"Just","year":"2018","journal-title":"RMD Open"},{"key":"2025090313362695000_10.1.e003705.9","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1002\/acr.24050","article-title":"Efficacy, Safety, and Sample Quality of Ultrasound-Guided Synovial Needle Biopsy in Clinical Practice and Research: A Prospective Observational Study","volume":"72","author":"Rom\u00e3o","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313362695000_10.1.e003705.10","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.151441"},{"key":"2025090313362695000_10.1.e003705.11","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2021.749062","article-title":"Editorial: Synovial Tissue: Turning the Page to Precision Medicine in Arthritis?","volume":"8","author":"Orr","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"2025090313362695000_10.1.e003705.12","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1002\/art.41726","article-title":"Inclusion of Synovial Tissue-Derived Characteristics in a Nomogram for the Prediction of Treatment Response in Treatment-Naive Rheumatoid Arthritis Patients","volume":"73","author":"Alivernini","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"2025090313362695000_10.1.e003705.13","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214539"},{"key":"2025090313362695000_10.1.e003705.14","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215751"},{"key":"2025090313362695000_10.1.e003705.15","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0939-8"},{"key":"2025090313362695000_10.1.e003705.16","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2021.705382","article-title":"The Crucial Questions on Synovial Biopsy: When, Why, Who, What, Where, and How?","volume":"8","author":"Ingegnoli","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"2025090313362695000_10.1.e003705.17","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223356"},{"key":"2025090313362695000_10.1.e003705.18","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1038\/s41591-022-01789-0","article-title":"Rituximab versus tocilizumab in rheumatoid arthritis: synovial biopsy-based biomarker analysis of the phase 4 R4RA randomized trial","volume":"28","author":"Rivellese","year":"2022","journal-title":"Nat Med"},{"key":"2025090313362695000_10.1.e003705.19","doi-asserted-by":"crossref","first-page":"e648","DOI":"10.1016\/S2665-9913(23)00241-2","article-title":"Stratification of biological therapies by pathobiology in biologic-naive patients with rheumatoid arthritis (STRAP and STRAP-EU): two parallel, open-label, biopsy-driven, randomised trials","volume":"5","author":"Rivellese","year":"2023","journal-title":"Lancet Rheumatol"},{"key":"2025090313362695000_10.1.e003705.20","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06708-y"},{"key":"2025090313362695000_10.1.e003705.21","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-221875"},{"key":"2025090313362695000_10.1.e003705.22","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-019-1263-7"},{"key":"2025090313362695000_10.1.e003705.23","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2222-z"},{"key":"2025090313362695000_10.1.e003705.24","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-018-1762-1","article-title":"Standardisation of synovial biopsy analyses in rheumatic diseases: a consensus of the EULAR Synovitis and OMERACT Synovial Tissue Biopsy Groups","volume":"20","author":"Najm","year":"2018","journal-title":"Arthritis Res Ther"},{"key":"2025090313362695000_10.1.e003705.25","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.181062"},{"key":"2025090313362695000_10.1.e003705.26","doi-asserted-by":"publisher","DOI":"10.1002\/art.27584"},{"key":"2025090313362695000_10.1.e003705.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2006.02508.x"},{"key":"2025090313362695000_10.1.e003705.28","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-022-00790-8"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2023-003705","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:36:34Z","timestamp":1756931794000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2023-003705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,2,13]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/rmdopen-2023-003705"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2023-003705","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}