Synovial Fluid as a Predictor of Response in Treatment of Rheumatoid Arthritis
IRB Number: 2025-1215
January 15, 2026
Institutional Review Board, Hospital for Special Surgery
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Principal Investigator
Co-Investigators
Summary of Study Intervention:
Researchers at Hospital for Special Surgery are trying to learn how synovial fluid features may be able to predict treatment response in rheumatoid arthritis (RA). This study focuses on conventional synthetic disease-modifying antirheumatic drugs (csDMARD) inadequate responders that are starting a new TNF inhibitor (TNFi). Eligible patients will be asked about their RA, and we will be collecting blood and synovial fluid for analysis of identified biomarkers. In doing so, we hope to bring precision medicine to the management of RA, particularly for those who have not been able to achieve lower disease activity with first-line treatment options. Study visits include baseline and 3-month follow-up visits. Subjects will have the opportunity to discuss any questions with the research team members and their treating rheumatologist. Enrollment begins in 2026 and we aim to enroll 110 participants.
Inclusion/Exclusion Criteria:
Inclusion Criteria
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- Age ≥ 18 years
- Meet 1987 ACR or 2010 ACR/EULAR RA criteria
- RF and / or anti-CCP positive*
*Note: Patients can be recruited based on any prior positive RF or CCP. For analysis of the synovial fluid, we need to know recent titers (within last 12 months) and therefore the labs will be repeated if not done within last year
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- Patient undergoing synovial fluid aspiration of an amenable joint (shoulder, elbow, wrist, hip, knee, ankle)
- Patient with inadequate response to csDMARDs(MTX, LEF, SSZ, HCQ) and biologic naïve*
*Note: Patients are allowed to be on current NSAID and steroid (oral or IM or intra-articular in a different joint) treatment
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- Patient starting any TNFiwithin next 4 weeks
Exclusion Criteria:
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- Unable or unwilling to provide informed written consent
- Joint replacement or other hardware in joint of interest
- Steroid or other injection into joint of interest within prior 30 days
- Regular use of direct oral anticoagulant therapy (DOAC), warfarin, high dose aspirin (>81 mg/day), Clopidogrel ≥75 mg/day or patients with diagnosed bleeding diathesis (e.g., hemophilia)
- Treatment with immunosuppression for reasonother than RA
Contact Information for the Study:
Grace Kim-Lambert
917.260.4514