The TRICIA Consortium is developing national capacity to perform standardised synovial tissue biopsies in children and young people with Juvenile Idiopathic Arthritis (JIA). Our goal is to create a UK-wide infrastructure with the expertise to perform, collect, process, and analyse synovial tissue samples—ensuring that future studies are inclusive, diverse, representative, and adequately powered.

A National Infrastructure for Synovial Biopsy Research

TRICIA is building a network of skilled centres across the UK, equipped to carry out biopsies across the full paediatric age spectrum. By embedding best practices for sample handling, data collection, and tissue analysis, we are ensuring consistency and quality across all participating sites.

Inclusive Approach to JIA Subtypes and Patient Groups

TRICIA includes all clinical subtypes of JIA, working toward a future where patients can be stratified by molecular classification rather than clinical labels alone.

In collaboration with the MAPJAG study, we are testing whether baseline synovial pathology can predict a child’s disease trajectory and treatment response—with tailored analysis for subtypes such as systemic JIA, which may follow different disease mechanisms.

The scale of our multicentre network allows for robust comparison both within individual subtypes and across the wider JIA spectrum.

Expanding Biopsy Capability to New Centres and Age Groups

To build sustainable capacity, TRICIA is:

• Extending biopsy programmes into older age groups,
• Setting up new biopsy centres across the UK, and
• Focusing on younger children who already undergo joint injections under general anaesthesia.

While new centres focus on younger age groups, experienced sites such as Birmingham Women’s and Children’s Hospital (BWCH) and Great Ormond Street Hospital (GOSH) are also including older children and adolescents, ensuring broader age representation in research.

Enabling Multicentre Synovial Biopsy Studies

By expanding the number of participating centres, TRICIA is increasing both the technical and intellectual capacity within the UK to deliver biopsy-driven clinical and experimental studies in JIA.

This will:

• Boost patient recruitmentacross diverse sites,

• Support grant applications through stronger collaborative links, and

• Enhance research quality and reproducibility via standardised protocols for biopsies, data capture, and analysis.

Including Adolescents and Young Adults

TRICIA is committed to including adolescents and young adults (ages 11–25) in JIA research. We use age-appropriate tools, such as patient-reported outcome measures and data collection systems, to reflect their unique needs and experiences.

Despite the fact that JIA often continues into adulthood, many studies stop at childhood. TRICIA is helping to close that gap by recruiting from both adolescent clinics (11–16) and young adult JIA clinics (16–25).

Looking Ahead

By building this national infrastructure, TRICIA is laying the foundation for high-impact research that is inclusive, patient-centred, and scientifically rigorous—ultimately helping to improve care and outcomes for children and young people with JIA.

🔗 View of network of sites →

TRICIA is dedicated to expanding the capacity for ultrasound-guided synovial biopsy procedures within the UK paediatric rheumatology community. This is essential to advancing research into juvenile idiopathic arthritis (JIA) and enhancing our understanding of joint inflammation in children.

Training Healthcare Professionals

The consortium is training healthcare professionals in ultrasound-guided synovial biopsy techniques, with senior clinicians leading the training at new participating centres. Expert specialists in the field provide support throughout the training process.

Training is extended to paediatric rheumatology and radiology fellows with expertise in musculoskeletal ultrasound ensuring sustainability of these skills within the field

Hands-On Training and Mentorship

Hands-on training is delivered through small group workshops held at Keele University’s Anatomy and Surgical Training Centre. Here, participants practice biopsy techniques using cadaveric tissue, under the guidance of experienced consultants. Local mentorship is also provided to further develop these skills in real-world clinical settings.

Online Materials

To support broader access, TRICIA is developing online training materials, including instructional videos, in collaboration with media teams from the University of Birmingham and University College London. These resources will be freely available to the rheumatology community in due course.

Tailored Support for Individual Centres

In addition to the general training framework, tailored face-to-face training and mentorship are provided to meet the specific needs of individual centres. This ensures that each site receives the support required to implement and sustain the procedures effectively.

Standardising Biopsy Procedures

TRICIA continues to develop and refine standard operating procedures (SOPs) for synovial biopsy collection and processing. SOPs for both large and small joint biopsies are already in place. The consortium is also standardising protocols for biopsy collection, processing, transportation, and storage, ensuring consistency across all study sites.

These protocols align with advanced tissue imaging and single-cell analysis methods, allowing the samples to be used in cutting-edge research on inflammatory diseases.

🔗 Explore our training programme →

TRICIA focuses on capturing data regarding the acceptability, tolerability, and safety of ultrasound-guided synovial tissue biopsy procedures in children and young people with Juvenile Idiopathic Arthritis (JIA). The network works to validate a dedicated age-adjusted patient-reported outcome measure (PROM) to evaluate these aspects of the procedure.

Feasibility and Early Development

TRICIA has already successfully tested the feasibility of performing synovial tissue biopsies in children. The consortium has developed specific PROM to evaluate the acceptability and tolerability of the procedure, ensuring that the patient’s perspective is central to the research. Alongside these, tools for collecting safety data and written protocols for the collection and processing of tissue samples have also been established.

Prospective Data Collection across Centres

TRICIA prospectively collects data on the acceptability, tolerability, and safety of synovial biopsy procedures, using clinical report forms and age-appropriate PROMs. These PROMs, adapted from adult synovial biopsy data, were first developed within MAPJAG but are not yet validated across a wider cohort. By including these PROMs as part of the core dataset in TRICIA, the network ensures that the paediatric PROM will be validated across multiple centres, in a larger cohort, and across the full age spectrum.

Ensuring Comprehensive Data for Future Research

By collecting these data in a systematic and multi-centre approach, TRICIA builds a robust evidence base for the acceptability, tolerability, and safety of synovial tissue biopsy procedures in children and young people with JIA. This data will be vital for refining biopsy procedures, improving patient experience, and ensuring the safety and effectiveness of these techniques in paediatric populations.

🔗 Read more about acceptability and safety →

Tissue Analysis Pipeline

TRICIA establishes a dedicated tissue analysis pipeline across the consortium, ensuring a standardised approach to sample processing, bio-banking, and analysis. This framework supports quality control validation and strengthens future funding applications by de-risking methodology across multiple sites.

Sample Processing and Standardisation

Tissue samples are processed at laboratory hub sites linked to clinical centres, where they are prepared for storage and transportation. Samples are then sent to the Rheumatology Research Group Laboratory at the University of Birmingham for quality control (QC) assessment before being stored or analysed in ongoing studies. To ensure consistency, sample collection—including biopsy technique, processing, transportation, and storage—is standardised across all sites. Protocols are optimised and harmonised to align with downstream applications such as advanced tissue imaging and single-cell analysis, ensuring comparability with other major tissue research initiatives in immune-mediated inflammatory diseases (IMIDs). Training for laboratory staff at hub sites is led by experts at the University of Birmingham (UoB) and University College London (UCL).

Advanced Tissue Analytics

Building on synovial tissue research in adult rheumatoid arthritis (RA), TRICIA applies advanced tissue analysis techniques to define synovial pathology in juvenile idiopathic arthritis (JIA). Single-cell sequencing and profiling technologies allow high-resolution mapping of disease pathways, identifying key effector cell populations within inflamed joints. This approach links synovial pathology to treatment response, supporting biomarker discovery, treatment stratification, and drug target identification.

Longitudinal biopsy studies are underway, examining synovial tissue pathology at different stages of arthritis. Techniques such as single-cell RNA sequencing (sc-RNAseq) and spatial transcriptomics are being used to define the cellular basis of disease, with the potential to drive a paradigm shift in JIA research. Expanding the TRICIA network will enable adequately powered studies to validate these findings and accelerate clinical translation.

Bio-Banking and Future Research

TRICIA ensures that bio-banked samples are available for future synovial tissue studies under the oversight of the Consortium Management Group (CMG) and Steering Committee (SC). Standardised procedures developed through the MAPJAG study are applied to maintain sample integrity, supporting high-quality research and maximising the potential for future discovery.

We have developed robust protocols and metadata standards for tissue and data collection.

TRICIA provides harmonised procedures for tissue processing and histological analysis, and a minimal dataset for clinical and laboratory information capture. These are aligned with national data standards to ensure compatibility across centres.

Establishing a Core Clinical Dataset

TRICIA is developing a standardised core clinical dataset to be captured alongside synovial tissue data, aligning with national initiatives for routine data collection in JIA. The consortium is creating standardised clinical report forms linked to biological sample collection, with data collated within a dedicated electronic database.

Building on progress made through UK JIA initiatives such as the UK JIA Biologics Registers, CAPTURE-JIA, and the UKRI-funded CLUSTER consortium, the network integrates agreed outcomes and common datasets, including patient-reported outcomes. As JIA is a rare disease, many children participate in multiple studies, making harmonised and shared data collection essential.

The consortium brings together expert members, collaborative partners, young people with JIA, and parents of children with JIA through targeted workshops. These discussions establish consensus on a core clinical dataset for synovial tissue-based studies, defining the type and frequency of samples (tissue, joint fluid, and blood) and the source and nature of linked clinical data. TRICIA ensures that the dataset aligns with existing national initiatives and major stratified medicine and tissue-based outcome studies, including ORBIT, CARTOGRAPHY, MAPJAG, AMP, the Human Cell Atlas, A-TAP, and IMID-Bio.

The network captures data using a dedicated REDCap database across participating TRICIA clinical sites, integrating with existing UK paediatric registries, such as BSpaR, where possible. Work focuses on establishing study protocols for the timing of paired biological sample collection. TRICIA builds on existing infrastructure and sample collection SOPs developed through other initiatives to ensure robust and practical sample collection for paediatric patients. These efforts maximise the potential for translating research findings into viable biomarkers for clinical practice.

🔗 Explore the tissue analysis pipeline →

TRICIA is establishing a central data warehouse platform to capture and integrate flow cytometric, computational, bioinformatic, and imaging data from synovial tissue biopsies and biological samples. This data is linked to clinical outcome measures and made accessible within the project and, ultimately, to the wider research community.

The network deposits validated, high-quality data in well-regarded public databases, such as the Human Cell Atlas, ensuring that it is searchable and reusable for future research. The TRICIA platform aligns with UK-wide initiatives, including UK-IMID Bio and the CLUSTER consortium, supporting comparisons across immune-mediated inflammatory diseases (IMIDs) and clinical translation. Standardised data definitions and quality control measures ensure consistency and interoperability with other datasets.

The tranSMART platform serves as the core database for TRICIA, integrating sample data and linked clinical information. This web-based platform presents molecular, phenotypic, and clinical data in an intuitive interface, enabling exploratory analysis and hypothesis generation. Tools such as Fractalis enhance data mining capabilities across IMID datasets, supporting cross-disease comparisons, biomarker discovery, and mechanistic insights into JIA.

TRICIA ensures that data is not only accessible through web interfaces but also via tranSMART APIs, allowing direct computational access for advanced meta-analyses. The network applies mathematical modelling, multi-scale computational approaches, and statistical analysis to uncover novel insights into JIA, maximising the impact of collected data and driving forward research in paediatric rheumatology.

🔗 Read more about our data platform →