Symptoms
The main symptoms of synovitis are redness, warming and swelling of the joint and pain, which occurs mainly during movement. All these symptoms are caused by the inflammatory cells that have migrated into the joint space and release enzymes and messenger substances into the joint space, so-called inflammation mediators. Especially after an acute overloading, for example after physical work or a sporting competition, the disease becomes noticeable by movement restrictions and pain. If the disease remains untreated, the inflammatory processes lead to permanent damage to cartilage and bone with chronic pain developing as a result.
Synovitis Score
The Synovialitis Score is the most widely used method for evaluating the severity of synovitis. The disease is assessed histologically by a pathologist, i.e. by microscopic examination of the synovial tissue. The synovialitis score is therefore a quickly available and at the same time inexpensive tool, which is of great benefit in the further planning of a targeted and effective therapy.
For this purpose, a biopsy of the joint capsule is performed and the tissue sample obtained is prepared for microscopic examination.Points are awarded according to the stage of the tissue changes and then added up. This results in a total score of 0 to a maximum of 9 points, with more severe forms of the disease achieving higher scores. Of particular interest is whether it is a low-grade synovialitis (0-4 pts.)
or a high-grade synovialitis (5-9 pts. ), as this allows conclusions to be drawn about the cause of the disease. Accordingly, low-grade inflammation is more likely to indicate a degenerative joint disease, such as osteoarthritis and accident-related joint damage. High-grade synovialitis, on the other hand, is more likely to be an underlying rheumatic disease, such as rheumatoid arthritis or psoriasis.
Therapy
The first step in treatment after diagnosis of synovitis is immobilization of the affected joint or entire limb. Regular cooling of the joint with ice packs or cool packs should be used to support the treatment. The cold leads to a reflex constriction of the vessels in the tissue that is strongly supplied with blood due to the inflammation and thus to a reduction of the swelling.
If these measures are carried out adequately, a significant reduction in symptoms can often be achieved within a few days. Nevertheless, the intake of pain-relieving and anti-inflammatory drugs such as ibuprofen and diclofenac is indispensable. Apart from this, treatment of the causal underlying disease should be carried out as far as possible.
If conservative (non-surgical) approaches cannot improve the symptoms or if the disease occurs more frequently, surgery is recommended. Nowadays, this is carried out in the form of a minimally invasive procedure, more precisely arthroscopy (joint endoscopy), usually under general anesthesia. In this procedure, the surgeon uses a few millimeter-sized incisions to access the joint space, through which a camera and other instruments are then inserted.
The ultimate goal of this procedure is to remove the mucosal growths, thus allowing the inflammatory processes to subside and the synovitis to heal. In severe cases, the complete removal of the synovial membrane, a so-called synovectomy, may be necessary. At the same time, relief of joint effusions can be achieved by removing excess synovial fluid, which can then be examined for its composition and the possible presence of bacteria.