Synovitis Treatment

Why and Where Does Synovitis Occur?

The synovium is a thin layer of connective tissue and it lines the tendon sheaths and joints. The synovial membrane is highly vascularized, allowing for the exchange of nutrients, oxygen, and waste products between the synovial fluid and the surrounding tissues. Disorders affecting the synovial membrane can lead to inflammation (synovitis) and dysfunction of the joint. The joints most commonly affected are the knees, hips, elbows, shoulders, and ankles. 

The most common causes of synovitis are listed below:

• Inflammatory conditions such as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, or ankylosis spondylitis.
• Bacterial, viral, or fungal infections can lead to inflammation of the synovial membrane.

Any direct trauma to the joint such as a fracture, sprain, or repetitive stress injury can lead to synovitis.

• Repetitive movements or overuse of the joint can lead to irritation and inflammation of the synovial joint.
• Other autoimmune conditions such as systemic lupus erythematosus (SLE) and spondyloarthropathies, may involve synovitis as part of their inflammatory manifestations.
• Rarely tumors arising from the synovial membrane such as synovial sarcoma can lead to inflammation of the synovial membrane.

Symptoms of Synovitis

Here are the symptoms associated with synovitis:

• Persistent or intermittent pain in the joint that can worsen with movement.
• Visible swelling of the joint due to the accumulation of synovial fluid.
• Warmth and redness are associated with the inflammation of the joint.
• Stiffness and reduced range of motion that can affect your daily activities.
• Grating, creaking, or popping sensations or sounds (crepitus) with joint movement
• A feeling of instability or “giving away”, particularly in the weight-bearing joints.

If you experience the above-mentioned symptoms, it is essential that you consult a healthcare professional for an accurate diagnosis and treatment.

How Common is Synovitis?

Arthritis is a common condition. As arthritis is a major cause of synovitis, it is quite common in people with arthritis. In fact, 2/3rds of people with different forms of arthritis have experienced synovitis at some point in time.

Diagnosis and Treatment For Synovitis

Diagnosis

Here are the diagnostic methods involved in diagnosing synovitis:

• Medical History: The doctor (preferably a rheumatologist) will ask you about your symptoms, their duration, and any history of underlying health conditions or joint injuries that could lead to synovitis.
• Physical Examination: S/he will inspect the affected joint for signs of redness, swelling, and warmth. They may also try moving the joint to check the range of motion and check if there’s any pain or discomfort during movement, as that would indicate synovitis. 
• Imaging Studies: Imaging tests for synovitis include X-rays, ultrasound, and MRI scans. They help better view the internal joint structure to assess the extent of joint inflammation, any joint damage, and the presence of fluid in the synovial cavity.
• Synovial Fluid Examination: If the doctor finds the presence of excess fluid in the joint, s/he may carry out joint aspiration (arthrocentesis) to collect the synovial fluid. Then this fluid is used to diagnose the cause of synovitis by analyzing its color, white blood cell count, and bacteria/crystals presence. 
• Blood Tests: Blood tests help in knowing as well as confirming the causes of synovitis.
• Biopsy: A small tissue sample from the synovium may be examined for signs of disease, especially when an underlying disease is suspected.

Your doctor may use one or more of the above-mentioned diagnostic methods for diagnosing synovitis.

Treatment

Here are the treatment methods for managing synovitis :

• Rest and Immobilization: Reducing activity levels can help reduce inflammation of the affected joint, and decrease pain. Braces or splints may be used to provide stability and prevent further discomfort and damage.
• Lifestyle Modifications: Maintaining a healthy weight and following an anti-inflammatory diet may also help better manage the symptoms, as they reduce the overall inflammation in the body.
• Medications: While NSAIDs (non-steroidal anti-inflammatory drugs) may be used to get relief in pain and inflammation, DMARDs (disease-modifying antirheumatic drugs) might be prescribed for autoimmune-related synovitis. 
• Physical Therapy: Therapy helps strengthen the muscles, improve the range of motion, restore function, prevent stiffness, and reduce pain.
• Joint Injections and Aspiration: Injecting corticosteroids directly into the joint may relieve pain and inflammation. Joint aspiration may be used to remove excess fluid build-up.  
• Surgery: Surgery is required when nonsurgical methods have failed to give effective results. Synovectomy (where most of the synovium is removed), arthroscopic surgery to repair/remove damaged tissue, and joint replacement are some of the possible options.  

It is important to note that treatment for synovitis will be individualized based on the underlying cause and the severity of the symptoms.

Synovectomy Procedure Details

Here are the general steps involved in the procedure:

• Anesthesia: The patient is administered general (to make the patient sleep during the procedure) or regional anesthesia (to numb only the surgical site).
• Incisions: Depending upon the type of procedure, a single large incision may be made for open surgery, while a few small ones are made for arthroscopy (where an arthroscope is used).
• Correction: Arthroscopic synovectomy is a minimally invasive procedure, where a tube with an attached camera is used to view the inside of the joint. Open synovectomy is for more complex cases. In both types, the inflamed synovium tissue is removed through the incision/s.
• Synovial Tissue Removal: Whichever procedure is used, the aim is to remove the inflamed tissue from the joint. The surrounding structures are preserved, and pain and inflammation are reduced.
• Closure: In arthroscopy, the incisions are closed with the help of sutures or staples. Finally, the surgical area is bandaged to protect the site and allow healing.

Synovectomy is generally considered a safe and effective treatment option for relieving pain and inflammation in individuals with chronic synovitis.

Recovery and Outlook

Recovery from a synovectomy can include the following:

• Rest and Immobilisation: It is important to keep the joint in a resting position initially to prevent undue stress. Splints and braces may also be used for stability.
• Pain Management: Medications, ice packs, and elevating the affected joint can help manage postoperative pain and reduce discomfort and swelling.
• Physiotherapy and Rehabilitation: Tailored exercises help improve the range of motion, strengthen the surrounding muscles, and reduce stiffness. These are important for recovery as well as return to normal activities.
• Gradual Return to Activities: Depending on the joint involved and the surgery carried out, a timeline is set for a return to normal/sports activities. It’s undertaken gradually to prevent overloading on the joint.
• Lifestyle Modifications: Adjustments like maintaining a healthy weight, incorporating low-impact exercises on a daily basis, and adopting an anti-inflammatory diet, all help strengthen the muscles without putting too much stress on the joints.
• Long-Term Management and Outlook: Follow-ups on a long-term basis may be required to monitor the condition and the results of synovectomy surgery. The outlook depends on the reason for the procedure, the overall health of the patient, and the rehabilitation process. Usually, patients find their symptoms reduced considerably, though ongoing management may be required.

Risks and Benefits of Synovectomy

Risks

Risks involved with a synovectomy may include the following:

• Infection
• Scar tissue
• Blood clots
• Nerve damage
• Tissue damage

You should contact the doctor in case of fever, intense pain, redness, and swelling, numbness and tingling, or drainage from the surgical site.
Benefits

Coming to the advantages of synovectomy, the surgery yields dramatic improvement in pain relief and function. Here is a list of the benefits of the procedure:

• Relief from pain and improved joint function
• Reduction in swelling
• Slower progression of the disease
• Reduced dependency on medications
• Better quality of life
• The option to get it done in a minimally invasive way for benefits such as shorter recovery times, smaller scars, and reduced postoperative pain
• Target the specific joints/areas, especially beneficial when the disease is localized