Rheumatologists at Diakonhjemmet Hospital are alone in Norway in using a gentle technique, which gives researchers direct access to the core of the disease.
Guro Løvik Goll, Hilde Berner Hammer and their colleagues are among the few in Norway who master synovial biopsy to extract tissue pieces in a gentle way. In the photo you see, from left, Julie Røkke Osen, Erlend Holm Nordli, Pernille Bolton-King, GLG, Alexander Mathiessen, HBH, Even Lillejordet and Birgitte Nellemann
With ultrasound-guided, minimally invasive synovial biopsy, they can extract small pieces of tissue from inflamed synovial membrane – and open up completely new knowledge about why joint diseases develop differently from patient to patient.
Big hopes for small pieces of tissue
The fact that rheumatologists Hilde Berner Hammer and Guro Løvik Goll master this technique is of great importance for the studies the hospital can conduct.
Together with other rheumatologists, Hammer and Goll have established a biopsy group that takes ultrasound-guided tissue samples from the synovial membrane.
What distinguishes one inflamed synovial membrane from another?
The inside of swollen joints often has a thick and inflamed synovial membrane. It is in this membrane that the inflammatory cells that maintain the joint disease are found.
Rheumatologists Hammer and Goll have been wondering for years what distinguishes one type of inflamed synovial membrane from another. What is it that causes the inflammation in some people not to improve with treatment with common medications? These are among the questions they have asked themselves.
Professor Emeritus, Hilde Berner Hammer
– Thanks to major advances in advanced laboratory analyses, we may soon have an answer to this, says Hilde Berner Hammer.
Gentle procedure opens new research opportunities
She explains that before they could only extract tissue from the joint if the patient was going to have surgery on the swollen joint. Now they can extract it from any joint that is large enough and sufficiently inflamed. The procedure takes about an hour and can be done in a regular examination room.
Guro Løvik Goll adds that they have also established collaborations with some of the best research groups in the world on synovial membrane analysis. They also collaborate with leading research groups in Norway.
– The dream is to be able to choose the right treatment for the individual patient, based on the disease profile of that particular person. We find that profile best where the disease hits hardest and most clearly, namely in the synovial membrane, says Goll.
Crucial support from the clinic
They are grateful that the management of the rheumatology ward has made arrangements for them to get the necessary equipment and space. They explain that these are procedures that are not done in a jiffy and that they would not have been able to carry out without their help.
The international literature shows that this is a minor procedure that is well tolerated by patients.
– We have now taken tissue samples from around 25 patients, and see that the procedure itself goes well and has no after-effects. It has been reassuring for us to experience this ourselves, says Goll.
The START study and new European research streams
REMEDY and Diakonhjemmet Hospital are involved in two major European research collaborations based on extracting tissue from the synovial membrane. In addition, REMEDY is already conducting a study on newly-onset arthritis (the START study) and several studies are being planned in collaboration with strong national and international communities.
– Such tissue samples are gold to add to our biobank. These are studies at the forefront of research. We hope we have the key to much better patient treatment in the samples we collect, says Goll.
Guro Løvik Goll emphasizes that there is a whole team working on this at the hospital. From left, Julie Røkke Osen, Erlend Holm Nordli, Pernille Bolton-King, GLG, Alexander Mathiessen, HBH, Even Lillejordet and Birgitte Nellemann
