Connective tissues - endothelial and underlying loose, lining the joint capsule from the inside - this is a synovial membrane that forms in the lateral flanks, in the upper inversion and in the anterior section of the fold and villus. When arthroscopy is performed, edema, color and vascular pattern are evaluated, as well as all pathological inclusions in the thickness of the synovium and on the surface, the size, shape, structure of synovial folds and villi are evaluated. All this is of great importance in the diagnosis of joint diseases. The synovium may become inflamed. Synovitis is the most common manifestation of chronic diseases. Chronic synovitis within the membrane indicates primary inflammation in arthritis and secondary in arthrosis that deforms the joint.
Synovitis
According to the latest information, the key link in the development of chronic arthritis is an autoimmune process, when an unknown pathogenic factor is recognized with the help of an antigen-presenting cell. Secondary synovitis of deforming arthrosis is associated with the accumulation of cartilage decay products in the joint - fragments of collagen molecules and proteoglycans, membraneschondrocytes and the like. In the normal state, not a single cell of the immune system comes into contact with these antigens, and therefore they are recognized as completely foreign material. This is what leads to a harsh immune response, and therefore is accompanied by such chronic inflammation, from which the synovial membrane suffers. Such changes in the knee joint are especially common. There are a lot of systemic diseases of the synovial membrane, and there is a certain classification for them.
1. Diseases with articular syndrome is a lesion of connective tissue by rheumatoid arthritis, when predominantly small joints are affected. This is a type of erosive-destructive polyarthritis, while the etiology is not too clear, and the autoimmune pathogenesis is complex.
2. Infectious arthritis, which is associated with the presence of infections, including latent ones. For example, the synovial membrane of the joint is affected by infections such as mycoplasma, chlamydia, bacteroids, ureplasma, and many others. This includes septic (bacterial) arthritis.
3. Diseases from metabolic disorders, such as gout, ochronosis (it is the result of a congenital disease - alkaptonuria), pyrophosphate arthropathy.
4. The synovial membrane of the joint is prone to neoplasms - tumors and tumor-like diseases. These are villezonodular synovitis, synovial chondromatosis, synovioma and hemangioma, synovial ganglion.
5. The defeat of the synovial membrane of the joint according to the degenerative-dystrophic type and deforming arthrosis are considered verycommon diseases. For example, many people over forty-five years old suffer from degenerative-dystrophic joint disease, and the degree of this lesion can be different.
About the disease
Synovitis is such a widespread disease that even the US military medicine is concerned about it, recently agitating Russia with a tender for the collection of RNA and the synovial membrane of Russians. This is explained by the fact that there is a persistent search for solutions in the fight against joint diseases in the world. The fact is that the inflammatory process is accompanied by an accumulation of effusion (fluid) in the joint cavity itself, and knee joints most often suffer, although the lesion can overtake the ankle, elbow, wrist, and any other joint. Diseases of the synovial membrane develop, as a rule, only in one of them; several joints are quite rarely affected. Synovitis develops from an infection, after an injury, from allergies and some blood diseases, with metabolic disorders and endocrine diseases. The joint increases in volume, the synovial membrane is thickened, pain appears, the person feels unwell and weak. If a purulent infection joins, the pain becomes much stronger, general intoxication may occur.
After the detection of symptoms, after examinations and studies of the synovial fluid, a diagnosis is made. This is, for example, inflammation of the synovial membrane of the joint. Treatment is prescribed: punctures, immobilization, if necessary - surgery or drainage. Given the course of the disease, acute synovitis and chronic synovitis can be distinguished. Acute is always accompanied by edema, plethora and thickening of the synovial membrane. The joint cavity is filled with effusion - a translucent liquid with fibrin flakes. Chronic synovitis shows the development of fibrous changes in the joint capsule. When the villi grow, fibrinous overlays appear, which hang down directly into the joint cavity. Soon, the overlays separate and turn into "rice bodies", floating freely in the fluid of the joint cavity and additionally injuring the membrane. According to the types of inflammation of the synovial membrane and the nature of the effusion, serous synovitis or hemorrhagic, purulent or serous-fibrinous can be distinguished.
Causes of occurrence
If pathogenic microorganisms enter the joint cavity, infectious synovitis occurs. The pathogen can penetrate into the shell with penetrating wounds of the joint - from the external environment, as well as from the tissues surrounding the sinoidal membrane, if there were purulent wounds or abscesses near the joint. Even from distant foci, the infection may well penetrate into the area of the joint cavity, causing inflammation of the synovial membranes of a person, since blood and lymphatic vessels pass everywhere. Infectious nonspecific synovitis is caused by staphylococci, pneumococci, streptococci and similar pathogens. Infectious specific synovitis is caused by pathogens of specific infections: with syphilis - pale treponema, with tuberculosis - tubercle bacillus, and so on.similar.
With aseptic synovitis, pathogenic microorganisms are not observed in the joint cavity, and inflammation becomes reactive. This happens if mechanical injuries occur - bruises of the joint, intra-articular fractures, damage to the meniscus, when the synovial membrane of the knee joint suffers, ligament ruptures and many more reasons. In the same way, aseptic synovitis occurs when irritated by free articular bodies, as well as previously damaged structures - a torn meniscus, damaged cartilage, and the like. Other causes of aseptic synovitis can be endocrine diseases, hemophilia and impaired metabolism. When an allergic person comes into contact with an allergen, allergic synovitis occurs. Treatment of the synovial membrane in this case is expected after the exclusion of the impact of the allergen on the patient's body.
Symptoms
In nonspecific acute serous synovitis, the synovial membrane is thickened, the joint is enlarged in volume. Its contours are smoothed, even a bursting feeling appears. The pain syndrome is not very pronounced, or absent. However, the movements of the joint are limited, with palpation, mild or moderate pain is felt. Malaise is possible, local and general temperature slightly increases. Palpation reveals fluctuation. The surgeon necessarily conducts the following tests: covers the opposite parts of the joint with the fingers of both hands and gently presses on either side. If the other hand feels a jolt, then the joint contains fluid. Synovi althe shell of the knee joint is examined by balloting the patella. When pressed, it plunges into the bone until it stops, then, when the pressure is stopped, it sort of floats up. Unlike purulent acute synovitis, there are no clear clinical manifestations here.
And acute purulent synovitis is always visible, since the patient's condition deteriorates sharply, signs of intoxication appear: a sharp chill, weakness, fever, even delirium is possible. The pain syndrome is pronounced, the joint with edema in volume is greatly enlarged, with hyperemic skin above it. All movements are extremely painful, in some cases joint contracture develops, and regional lymphadenitis is also possible (nearby lymph nodes increase). Chronic synovitis can be serous, but the form is observed most often mixed: vilenohemorrhagic, serofibrinoid, and the like. In these cases, the clinical symptoms are poor, especially in the earliest stages: aching pain, the joint gets tired quickly. In chronic and acute aseptic synovitis, the effusion may become infected, followed by a much more severe infectious synovitis. This is why the study of RNA and the synovial membrane is so important.
Complications
Infectious processes can spread far beyond the joint and its membrane, moving to the fibrous membrane, which leads to the onset of purulent arthritis. Joint mobility is provided precisely by the state of the synovial membrane and ribonucleic acid, which implements the geneticinformation about the person. The process spreads further: phlegmon or periarthritis develops on the surrounding soft tissues. The most severe complication of infectious synovitis is panarthritis, when the purulent process covers all the structures that are involved in the formation of the joint - all bones, ligaments and cartilage. There are cases in which sepsis becomes the result of such a purulent process. If chronic aseptic synovitis exists in the joint structure for a long time, many unpleasant complications appear.
The joint gradually, but constantly, increases its volume, because the synovial membrane of the hip joint, knee or shoulder does not have time to absorb excess fluid back. If there is no treatment for such chronic diseases, dropsy of the joint (hydrarthrosis) may well develop. And if there is dropsy in the joint for a long time, the joint becomes loose, the ligaments cease to fulfill their function, as they weaken. In these cases, not only subluxation of the joint, but also a complete dislocation often occurs.
Diagnosis
After analyzing the clinical signs that are obtained after research and diagnostic puncture, a diagnosis is made. This confirms not only the presence of synovitis, but the causes of its appearance must be identified, and this is a much more difficult task. To clarify the diagnosis of the underlying disease in chronic and acute synovitis, artropneumography and arthroscopy are prescribed. A biopsy and cytology may also be required. If there is a suspicion of hemophilia, metabolic or endocrine disorders, it is necessaryappointment of appropriate tests. If an allergic nature of inflammation of the synovial membrane is suspected, allergic tests should be performed. The most informative is the study of fluid obtained with the help of a diagnostic puncture - punctate. In the acute aseptic form of synovitis acquired as a result of trauma, the study will show a large amount of protein, which is evidence of high vascular permeability.
Reducing the total amount of hyaluronic acid also reduces the viscosity of the effusion, which characterizes the absence of a normal state of the synovial fluid. Chronic inflammatory processes reveal an increased activity of hyaluronidases, chondroproteins, lysozyme and other enzymes, in which case disorganization and accelerated destruction of cartilage begin. If pus is found in the synovial fluid, this indicates the process of purulent synovitis, which must be examined by a bacterioscopic or bacteriological method, which will make it possible to establish the specific type of pathogenic microorganisms that caused inflammation, and then select the most effective antibiotics. A blood test is required to detect an increase in ESR, as well as an increase in the number of leukocytes and stab neutrophils. If sepsis is suspected, additional blood cultures are needed.
Treatment
The patient needs rest, maximum restriction of the movements of the affected joint, especially during an exacerbation. Externally and internally assignedanti-inflammatory drugs - "Nimesil", "Voltaren" and the like. If the synovitis is pronounced, injections are prescribed, which then turn into tablet forms of treatment. If there is significant accumulation of fluid in the joint, a puncture is indicated, which, in addition to diagnostic, has therapeutic value. Diagnosis is as follows: purulent arthritis and hemarthrosis (blood in the joint cavity) are differentiated, a cytological examination (especially with crystalline arthritis) of the joint fluid is performed. During the puncture, a yellowish liquid is obtained in a fairly large amount (especially with inflammation of the synovial membrane of the knee joint - more than one hundred milligrams). After removing the liquid, anti-inflammatory drugs are injected with the same needle - kenalog or diprospan.
If the cause of the disease is established and the amount of fluid in the joint is insignificant, the patient will be treated on an outpatient basis. If inflammation of the synovial membrane occurs as a result of an injury, the patient is sent to the emergency room. Symptomatic synovitis of the secondary plan should be treated by specialized specialists - endocrinologists, hematologists, and so on. If the amount of effusion is large, and the disease is acute, this is an indication for hospitalization. Patients with traumatic synovitis are treated in the traumatology department, with purulent synovitis - in surgery, and so on - according to the profile of the underlying disease. Aseptic synovitis with little effusion involves tight bandaging of the joint, elevation, and immobilization of the entire limb. Patients are referred for UHF, UV irradiation, electrophoresis with novocaine. A large amount of fluid in the joint suggests therapeutic punctures, electrophoresis with hyaluronidase, potassium iodide and phonophoresis with hydrocortisone.
Therapy & Surgery
Acute purulent synovitis requires mandatory immobilization with an elevated position of the limb. If the course of the disease is not severe, pus is removed from the joint cavity by puncture. If a purulent process of moderate severity occurs, continuous and long-term flow-aspiration lavage with an antibiotic solution of the entire joint cavity is required. If the disease is severe, the joint cavity is opened and drained. Chronic aseptic synovitis is treated through the treatment of the underlying disease, tactically the treatment is set individually, taking into account the severity of the disease, the absence or presence of secondary changes in the synovial membrane and the joint, punctures are performed and peace is provided.
In appointments there are anti-inflammatory drugs, glucocorticoids, salicylates, chymotrypsin and cartilage extract. After three or four days, the patient is sent for paraffin, ozokerite, magnetotherapy, UHF, phonophoresis or other physiotherapeutic procedures. If significant infiltration is present and relapses are frequent, aprotinin is injected into the joint cavity. Chronic synovitis with irreversible changes in the synovial membrane, its stubbornly recurring forms require surgical intervention - complete or partial excision of the synovial membrane. The postoperative period is devotedrehabilitation therapy, which includes immobilization, anti-inflammatory drugs, antibiotics and physiotherapy.
Forecast
Prognosis is usually good for allergic and aseptic synovitis. If the therapy is carried out adequately, all inflammatory phenomena are almost completely eliminated, the effusion in the joint disappears, and the patient can now move in any volume. If the form of the disease is purulent, complications often develop, contractures form. There may even be a danger to the life of the patient. Chronic aseptic synovitis is often accompanied by stiffness, and in a number of cases relapses occur, contractures develop after synovectomy. It should be noted that synovitis almost always accompanies any chronic diseases in the joints, and therefore relapses are possible.
To reduce the inflammatory process that occurs in the synovial membrane, a course of anti-inflammatory injections is carried out, as well as the introduction of glucocorticosteroids into the damaged joint if there are no congenital pathologies of the joint (sometimes, even with pathological changes, diagnostic arthroscopy and appropriate treatment are performed). This relieves pain, and the joint gradually begins to work better. The main thing is to eliminate the main cause of synovitis, and if you then remove the affected part of the synovial membrane, this will certainly lead to a positive result. The prognosis is not bad for the consequences of surgery.
Consequences
Quite often situations occurcomplete recovery with restoration of joint mobility. Loss of function occurs only in severe forms of purulent varieties of synovitis, and these cases sometimes even lead to the death of the patient from blood poisoning. This disease is not to be taken lightly. Children usually get sick for a week or two, everything ends without any dangerous consequences. In adults, it is different, since most often the origin of the disease is not traumatic. In no case can one hope for self-healing, since sepsis and death can occur.
In order for this disease to pass by, you must always treat all infectious diseases in a timely manner, and exercise moderately. As soon as discomfort is felt, immediately give the joints a rest, if the discomfort does not stop, consult a doctor. Running forms lead to the need for surgical intervention, although such cases of disability are not too frequent.
