This protocol will examine blood, synovial fluid and synovial tissue from patients with
rheumatoid arthritis and other chronic inflammatory joint diseases to study genetic and
immunologic factors involved in the cause, development and progression of these conditions.
Synovial fluid is the lubricating fluid in joints. The synovial membrane is a delicate
tissue lining the inner surface of joints, which, in arthritic conditions, thickens and
becomes infiltrated with various types of cells.
Patients with rheumatoid arthritis and certain patients with other forms of arthritis may be
eligible for this study. Those enrolled will be followed periodically for follow-up and
disease evaluation. They may undergo the following procedures:
1. Synovial fluid aspiration, when medically indicated (for example, for joint swelling
and inflammation). For this procedure, an area of skin around the joint is numbed with
an anesthetic, and a needle is inserted into the joint to withdraw a small fluid
2. Periodic blood sampling, not to exceed 450 milliliters (15 ounces) during any 6-week
period, for genetic studies of rheumatoid arthritis. The samples are usually taken at
the same times that synovial fluid is withdrawn.
3. Synovial tissues, collected by needle biopsy or during surgical procedures for
arthroscopy (examination of the interior of the joint and repair of the joint) or total
joint replacement. For the needle biopsy, the skin over the biopsy site is washed and
anesthetized. A needle is inserted and fluid is aspirated. The biopsy needle is then
inserted through the outer needle and a tissue sample is suctioned.
Patients who qualify for other research studies may be invited to participate.
Blood, synovial fluids and/or synovial tissues will be obtained from patients with
rheumatoid arthritis and related chronic inflammatory arthritides. The synovial tissues
will be obtained by one of the following methods: a) needle biopsy, or b) at the time of a
total joint replacement or a therapeutic arthroscopic procedure. These materials will be
utilized for laboratory studies of etiopathogenetic mechanisms of rheumatoid arthritis and
related autoimmune joint diseases.
Patients with rheumatoid arthritis, particularly new onset disease, but certain patients
with other forms of arthritis will also be included.
Significantly swollen or tender knee or significantly swollen shoulders, elbows, wrists,
ankles, olecranon bursa or even smaller joints.
Synovial tissue specimens will not be obtained from patients when any of the following
conditions are present: abnormal bleeding or clotting tests, platelet count less than
100,000, or sepsis.