#synovitis

I'm so sick of lupus I'm so sick of lupus!!!

I am on prednisone. I am on saphnelo. my knees are so inflamed I cannot sleep. I don't know what the fuck to do at this point?? it's not bad enough for methotrexate yet it is bad enough that I don't want to do nothing

it feels like someone has taken a dagger and shoved it in my knee and hip joint sockets and is trying to pry apart the joints like someone cutting apart a rotisserie chicken. I am a rotisserie chicken and my own immune system is the butcher. I can feel it spreading to my ankles. my hands are so stiff I'm struggling to type and don't have full ROM

and the worst part is I'm so extremely fatigued that I need to sleep more. but I can't. why? dagger in my legs

But on the journey to like...keeping my ability to walk (though I've lost the ability to hike and/or walk more than 10 minutes which blows, I'm hoping to get it back still), my physiotherapist, who is also a personal trainer, got me doing a whole bunch of upper body stuff, which I cringed at and was like 'nooooooo' and just 'I'm gonna be so bad at thissss'

But it ended with me actually really enjoying it and now I bench press (don't ask me how much, it's a pitiful amount, my arms are as strong as limp noodles and i'm not not interested in 'how much can you do i bet i'm better at it than you are' like yes you are yes you are now go away) and I look forward to my arm workouts the most out of anything I do.

Image SC8953 (Rheumatoid Arthritis, X-ray)

Colored X-ray of a hand showing Rheumatoid Arthritis. The joints have become inflamed, causing the hand to become deformed. 

Rheumatoid arthritis is the second most common arthritic disease after osteoarthritis. Like many other rheumatic diseases, rheumatoid arthritis is an autoimmune disease (auto means self), so called because a person’s immune system, which normally helps protect the body from infection and disease, attacks joint tissues for unknown reasons. 

Learn More About Rheumatoid Arthritis

White blood cells, the agents of the immune system, travel to the synovium and cause inflammation (synovitis), characterized by warmth, redness, swelling, and pain – typical symptoms of rheumatoid arthritis. During the inflammation process, the normally thin synovium becomes thick and makes the joint swollen, puffy, and sometimes warm to the touch.

As rheumatoid arthritis progresses, the inflamed synovium invades and destroys the cartilage and bone within the joint. The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak and unable to work normally. These effects lead to the pain and joint damage often seen in rheumatoid arthritis. 

Researchers studying rheumatoid arthritis now believe that it begins to damage bones during the first year or two that a person has the disease, which is one reason why early diagnosis and treatment are so important. Some people with rheumatoid arthritis also have symptoms in places other than their joints. 

Many people with rheumatoid arthritis develop anemia, or a decrease in the production of red blood cells.It is caused by the immune system attacking the body's own tissues. It typically affects finger, wrist and toe joints. 

Treatment for pain, inflammation and restricted movement is with anti-inflammatory drugs. Physiotherapy may help to preserve joint movement.

Authored by: Jawed Akram

Abstract

Chronic Synovitis presents a diagnostic dilemma for clinicians and surgeons. In our study we investigated patients presenting with chronic synovitis of wrist joint with wrist arthroscopy. 8 out of 34 (23.53%) of cases were histologically positive for granulomas suggestive of tuberculosis. We were able to predict the etiology of the disease based on the arthroscopy findings.

Introduction

Chronic synovitis of wrist joint is a common manifestation seen in a majority of cases of inflammatory arthritis especially rheumatoid arthritis, the involvement in these cases is usually poly-articular, but occasionally oligo- articular and mono articular involvement may be seen. In the Indian population tuberculosis of wrist joint is an important differential diagnosis to be kept when a patient presents with Mon-articular wrist swelling.

Methods

We investigated 34 patients presenting to our clinic with symptoms of chronic synovitis of wrist joint in the time duration between January 2014 to June 2021. We included the patients with a single joint involvement excluding those with oligo articular or poly articular involvement. All of these patients have been treated initially with non-steroidal anti-inflammatory drugs. We excluded patients with symptoms less than three months duration. The patients were investigated and scheduled for diagnostic arthroscopy with synovial biopsy. None of the patients complained of fever as the presenting complaint. Family history positive for tuberculosis was present in two of the patients. Chest X-rays were normal in all but one patient which showed right upper lobe infiltrates [Table 1]. The mean ESR was recorded to be 38.7 [Table 2]. All of the patients had a past history of BCG vaccination. Past history of tuberculosis was present in one patient ten years back which was treated with directly observed treatment for a period of six months. The rheumatoid factor was positive in eleven of the cases. The mean duration of involvement in these cases was 5.5 months. X-rays of wrist joint were taken and found to be normal in 22 out of 24 cases whereas the rest 12 there were features like juxta-articular osteopenia, periarticular erosion etc. Wrist arthroscopy was performed in these patients with a diagnostic intent and synovial biopsy was taken from the involved synovium which was sent for histopathological examination.

Table 1:clinical detail.

Table 2:Arthroscopic findings in the 2 groups.

Literature Review

Reports tuberculosis infections of wrist have been scarce, especially during past 30 years. Role of arthroscopy of wrist joint for tuberculosis infection has not been reported as yet. Arthroscopy has now been a standard therapy for rheumatoid arthritis of wrist allowing effective pain relief and high patient satisfaction [1]. Most of the report of tuberculosis within literature concentrate around atypical mycobacterial infection. Tuberculosis infection in wrist joint can come of variety of pathology including tuberculous arthritis, synovitis, tenosynovitis, soft tissue tuberculosis. Most striking feature of previous studies was delay between the onset of symptoms and the correct diagnosis. Most of earlier studies revealed an absence of pulmonary symptoms [2]. [Figure 1] Formation of rice like bodies has been explained in an earlier case report [3]. Earlier series express open synovectomy of wrist both as a diagnostic and therapeutic tool [4].

Surgical technique: The 3-4 and 4-5 portals were used as standard entry portals for radio-carpal joint. Additional 1-2 and 6U portals were also used occasionally to view dorsal side of radiocarpal joint. Adequate synovial biopsy specimen was taken from the region of synovium which visibly seemed to be maximally involved [Figure 2]. We noticed some peculiar findings in a subgroup of patients which didn’t comply with the characteristically described synovium in inflammatory diseases like rheumatoid arthritis. The peculiar features which were observed in these patients were absence of hypertrophic synovium (12 out of 34), absence of pannus formation (18 out of 34), atrophic villi (12 out of 34). 4 of the patients revealed small rice like bodies from the synovium [Figure 3].

Assessment: We tried to correlate our arthroscopic findings with the histopathological diagnosis. Absence of pannus and atrophic villi like architecture was strongly associated (66% 8 out of 12) with visibility of granulomas on histopathology. Both of the two patients whose synovium revealed rice like bodies showed features suggestive of granulomatous inflammation on histopathology. Overall, 8 out of the 34 patients were diagnosed as having tuberculosis on histopathological grounds [Figure 4,5]. Ziel Nielson staining failed to reveal acid fast bacilli in any of the case. A single patient developed growth of Mycobacterium tuberculosis on culture in LJ medium.

Conclusion

Tuberculosis must be kept as a differential diagnosis in cases presenting as chronic synovitis of wrist especially in tuberculosis endemic zones of southeast Asia. An early arthroscopy and arthroscopic synovial biopsy must be considered in these cases in order to establish a diagnosis. Arthroscopic examination can serve as a good predictor of etiology, but histopathology and culture remain the gold standard.

Read more: Full Text

For more articles in Archives of Rheumatology & Arthritis Research please click on: https://irispublishers.com/arar/archive.php

 As he can display in two clinical forms as acute and chronic. As in acute form clinical displays are  expressive character having, and liquid in joint cavity is serouse and pus,as in serouse synovitis clinical picture is not clear, as in pus. As on last case are intensive skin redness in joint region , strong aches, whole intoxications with bad feeling, weakness, high body temperature , and pus synovitis as arthritis is hard condition and needing help at hospital.

A chronic kind is having with less visible clinical displays and periodically  recidives, that acuting displaying,as this a investigation for other chronic diseases as metabolism destroys, autoimmune, or of wrong curing acute synovitis.

Knee Synovitis – Causes, Symptoms & Treatment

Swelling of the knee joint with stiffness and an appearance of a reddish hue could mean knee synovitis. This is usually considered as a chronic knee pain condition.

The condition is a result of the inflammation of the synovial membrane in the knee joint. This membrane functions to lubricate the joint for proper range of motion.

Synovial joints such as the knees, shoulders, and hip are covered in…

Global Journal of Orthopedics Research

Authorized by Safaa Eldin Abaza*

Three cases of sever synovitis and tenosynovitis of the wrist were sent to the author for surgical synovectomy and tenosynovectomies after failure of the medical treatment with biological and disease modifying drugs all of them turn to be tuberculous tenosynovitis after incidental soft tissue and synovial fluid culture, a discussion for the link between both different entity diseases and Awareness of Drug-specific risk of tuberculosis in patients with rheumatoid arthritis.