Clinical application of synovial biopsy in noninflammatory and persistent inflammatory refractory rheumatoid arthritis
Main finding · Synovial histopathologyResult — go to the resultRelative risk 1.6 95% CI 1.2–2.9Authors' conclusion
Our findings demonstrate distinct synovial and clinical phenotypes in refractory RA. Although PIRRA appears driven by active synovial inflammation and immune cell infiltration, NIRRA involves predominantly pauci-immune/fibroid histology with significant noninflammatory contributors to disease burden.
Study context
- Population
- Adults with established rheumatoid arthritis (RA) and active disease (CDAI >10), two academic rheumatology centres
- Participants
- 93 biopsied patients
- Exposure
- PIRRA vs noninflammatory refractory RA (NIRRA) vs nonrefractory RA (NORRA)
- Outcome
- Synovial pathology: Krenn Synovitis Score and immunohistochemistry pathotype (lympho-myeloid, diffuse-myeloid, pauci-immune/fibroid)
Methodological detailsobservational, two academic rheumatology centres, ultrasound-guided synovial biopsy
- Observational
- Two academic rheumatology centres
- Ultrasound-guided synovial biopsy
Main finding
Synovial histopathology
Relative risk
1.6
95% CI 1.2–2.9
P = 0.006
Events by group
NIRRA
47.6%
21/43 events
NIRRAvs PIRRA
RR 1.6 (95% CI 1.2–2.9); P = 0.006
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| PainNIRRA vs PIRRA · significantly greater pain in NIRRA · similar overall disease activity scores | P = 0.005 |
| Opioid useNIRRA vs PIRRA · higher opioid use in NIRRA | P = 0.015 |
Health-related quality of life
- Worse in NIRRA than PIRRA or NORRA
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Clinical application of synovial biopsy in noninflammatory and persistent inflammatory refractory rheumatoid arthritis. Ann Rheum Dis. Published 22 August 2025. doi:10.
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