Our research focuses on developing standardised procedures for synovial biopsy collection and processing. In our current study (MAPJAG), we perform minimally invasive, ultrasound-guided synovial tissue biopsies in children undergoing joint injections under general anaesthesia as part of routine clinical care. Integrating the biopsy procedure with the joint injection minimises additional risk and ensures a streamlined approach. Where possible, we also collect matched blood and synovial fluid samples, which are cryo-stored for future analysis.
Paediatric interventional radiologists carry out the synovial biopsies. We have already developed standard operating procedures (SOPs) for both large and small joint biopsies. Through this project, we are validating these procedures across multiple centres, ensuring high-quality sample collection through rigorous quality control measures.
Expanding the capacity for synovial biopsy procedures within the UK paediatric rheumatology community is essential to advancing research into juvenile idiopathic arthritis (JIA). To achieve this, we are training healthcare professionals in ultrasound-guided synovial biopsy techniques. Senior clinicians lead the training of operators at new participating centres, with expert support from specialists in the field. Training follows standardised protocols and best practices to ensure consistency across all sites.
Our approach includes two phases. First, we train paediatric interventional radiologists, rapidly increasing capacity across the consortium. Second, we extend training to paediatric rheumatology and radiology fellows who have expertise in musculoskeletal ultrasound. This ensures long-term sustainability and strengthens expertise within the field. Hands-on training takes place through small group workshops at Keele University’s anatomy and surgical training centre, where participants practice biopsy techniques using cadaveric tissue. Experienced consultants then offer local mentorship to further develop these skills.
We are developing online training materials, including instructional videos, in collaboration with media teams at the University of Birmingham and University College London. These resources will be made freely available to the rheumatology community through this website. Tailored face-to-face training and mentorship will also be provided to meet the needs of individual centres.
All tissue samples are processed at designated laboratory hubs before being sent to Birmingham for quality control checks, storage, or further analysis. We are standardising protocols for biopsy collection, processing, transportation, and storage to ensure consistency across all study sites. These protocols align with advanced tissue imaging and single-cell analysis methods, allowing the collected samples to be used in cutting-edge research on inflammatory diseases.
Laboratory staff at each hub receive training to ensure proper handling of samples. This training is led by experienced laboratory teams at the University of Birmingham and University College London, ensuring that all procedures meet high scientific and ethical standards.
By expanding training, improving standardised procedures, and ensuring high-quality sample collection, this project is paving the way for large-scale, multi-centre studies that will advance our understanding of joint inflammation in children and improve future treatments.
