What happens in the joint and what forms there are
The synovium lines the inside of the joint and produces a viscous fluid that nourishes the cartilage and reduces friction. When irritated, the membrane swells, the vessels dilate, and the fluid becomes several times more than normal. The joint enlarges, the capsule stretches - hence the feeling of fullness. If the inflammation is sterile, the fluid is clear or slightly cloudy. When infected, it becomes purulent and quickly destroys cartilage, so this form requires emergency care.
- Aseptic - after injury, with arthrosis, overload
- Infectious (purulent) - when bacteria enter, requires urgent treatment
- Reactive - response to an infection of another location
- Chronic - for rheumatoid arthritis, gout, repeated injuries
- Pigmented villonodular - a rare tumor-like form
Causes and risk factors
The most common cause in active people is injury: bruise, sprain, meniscus injury, repetitive overuse. In older people, synovitis often accompanies arthrosis: particles of destroyed cartilage irritate the membrane. A separate group is inflammatory and metabolic diseases: rheumatoid arthritis, gout, psoriatic and reactive arthritis, ankylosing spondylitis. Infectious synovitis develops from penetrating injury, injection into a joint, or the introduction of bacteria in the blood, and the risk is higher in people with diabetes and a weakened immune system.
- Injuries and damage to menisci and ligaments
- Arthrosis and joint overload
- Rheumatoid, psoriatic, reactive arthritis
- Gout and other metabolic disorders
- Bacterial infection from a wound or injection
- Excess weight and heavy physical work
- Diabetes mellitus and reduced immunity
Symptoms
The joint increases in volume, the contours are smoothed, the skin over it may be warm. Movements are limited: it is impossible to straighten or bend the joint completely, and a feeling of tight distension appears. The pain with aseptic synovitis is moderate, aching, and intensifies with exercise. With purulent inflammation, the picture is different: the pain is sharp, the joint is hot and red, the temperature rises, and weakness increases. Chronic synovitis is milder - the joint periodically swells, gets tired quickly, and there is stiffness in the morning.
- Swelling and smoothed contours of the joint
- Feeling of fullness and stiffness
- Aching pain that gets worse with exercise
- Local increase in skin temperature
- In the purulent form - fever, chills, sharp pain
- Repeated swelling during chronic course
Diagnostics
The doctor examines the joint, checks for effusion using special techniques, and evaluates the range of motion and the condition of the ligaments. Ultrasound of the joint is the most accessible way to confirm fluid, assess its amount and the condition of the membrane. An X-ray is needed to exclude a fracture and assess arthrosis, an MRI is needed if damage to the meniscus, ligaments or tumor process is suspected. If there is a lot of effusion or there is a suspicion of infection, a puncture is performed: the fluid is examined for cells, crystals and bacteria. Blood tests show inflammation and, if necessary, check for rheumatoid factor and uric acid.
- Examination and patellar balling test
- Ultrasound of the joint to assess effusion
- X-ray of joints and bones
- MRI for suspected meniscus or ligament damage
- Joint puncture with fluid analysis
- General and biochemical blood test, uric acid
Treatment and prevention
Treatment is always aimed at the cause. For traumatic synovitis, rest, an elevated position, cold in the first day, elastic fixation and gradual return of the load are needed. If there is a large effusion, the doctor performs a puncture: this simultaneously relieves the distension and provides material for analysis. Anti-inflammatory drugs are prescribed by the doctor for a short course. For gout and rheumatoid arthritis, basic therapy from a rheumatologist is needed, for arthrosis - weight loss and muscle strengthening. Purulent synovitis is treated in the hospital with antibiotics and drainage of the joint - self-medication is dangerous here. After the inflammation subsides, physical therapy and exercise therapy are added to restore mobility and not lose muscle strength.
- Rest and unloading of the joint during the acute period
- Puncture and evacuation of fluid in case of large effusion
- Anti-inflammatory drugs as prescribed by a doctor
- Treatment of the underlying disease by a rheumatologist
- Antibiotics and drainage for purulent form
- Magnetic therapy and other physical therapy after inflammation subsides
- Physical therapy and strengthening of muscles around the joint
- Weight control and adequate exercise for prevention