Joint Synovitis

The ability of hydroxylapatite to accept foreign ions into its structure and onto the surface has been used to incorporate radionuclides. Radioactive samarium and rhenium have been incorporated into hydroxylapatite microspheres sized at 20-40 pm and injected into knee joints to treat rheumatoid joint synovitis (Chinol et al. 1993). Clinical studies have shown that hydroxylapatite particles are easily labeled with radionuclides, exhibit low leakage of radioactive species, and provide a reduced inflammation of the synovium and restored joint motion to the patient (Clunie et al. 1996). 

Fig. 10.66a,b. Distal radio-ulnar joint synovitis, a Distal and b proximal transverse 12-5 MHz US images obtained over the dorsal aspect of the distal radio-ulnar joint at the levels horizontal black bars) indicated in the diagram on the left show the proximal recess distended by fluid (arrows). No effusion is seen at the level of the articular cartilages. The inserts at the upper right sides of the figure indicate probe positioning... 

Fig.l0.68a-d. Distinguishing joint synovitis versus extensor tenosynovitis with US. a,b Transverse 12-5 MHz US images obtained over the dorsal wrist in two patients with rheumatoid arthritis each presenting with tenderness and swelling over the dorsal right wrist. In a, the synovial effusion (asterisks) is closely apposed to the wrist bones because the inflammatory process involves the dorsal recesses of the wrist joints, whereas the overlying extensor tendons (T) are spared. In b, the effusion (asterisks) occurs all around the extensor tendons (T) as an expression of tenosynovitis, while the dorsal recesses of the wrist joints are normal. c,d Diagram correlations... 

Fig. 11.53a,b. Interphalangeal joint synovitis, a Longitudinal 15-7 MHz US image over the palmar aspect of the proximal interphalangeal joint with b diagram correlation demonstrates mild effusion inside the volar synovial recess (arrowheads) of the joint. Note the relationship of this recess with the palmar plate (asterisk), the flexor tendons (ft) and the edge of the head of the proximal phalanx (star). In b, the dorsal recess (arrow) of the joint is also depicted. PP, proximal phalanx MP, middle phalanx... 

Synovitis Inflammation of the synovial membrane, especially when a joint is involved. 

Upon arising, joint stiffness typically lasts less than 30 minutes and resolves with motion. Joint enlargement is related to bony proliferation or to thickening ofthe synovium and joint capsule. The presence of a warm, red, and tender joint may suggest an inflammatory synovitis. 

Nonspecific prodromal symptoms that develop insidiously over weeks to months may include fatigue, weakness, low-grade fever, loss of appetite, and joint pain. Stiffness and myalgias may precede development of synovitis. 

Rheumatoid arthritis is a chronic, systemic disorder that affects many different tissues in the body, but is primarily characterized by synovitis and the destruction of articular tissue.49,90 100 This disease is associated with pain, stiffness, and inflammation in the small synovial joints of the hands and feet, as well as in larger joints such as the knee. Although marked by periods of... 

Methotrexate (Folex, Rheumatrex) is an antimetabolite used frequently in the treatment of cancer (see Chapter 36). There is considerable evidence that this drug is also one of the most effective DMARDs.15 76 Methotrexate has been shown to slow the effects of rheumatoid arthritis as evidenced by decreased synovitis, decreased bone erosion, and less narrowing of the joint space.37 The therapeutic effects of methotrexate have also been reported to be equal to, or better than, other DMARDs such as oral gold or azathioprine, and methotrexate may offer an advantage in terms of a rapid onset.68,90 Hence, methotrexate s popularity as a DMARD has increased during the past few years, and this drug is often the first DMARD used to treat rheumatoid arthritis in both adults and children.76... 

Al is also present in the synovial fluid and arthritis-like symptoms have been reported in patients with Al bone disease, possibly due to an inflammatory effect on the synovial cells [107, 108]. We did not see signs of arthritis shortly after the intoxication, but after several months of treatment with desferrioxamine, three patients developed a possible transient synovitis with hydrops in the knee joints. 

Joint or muscle pains have sometimes been reported in patients receiving aldesleukin, as has shoulder arthralgia with normal radiography and scintigraphic imaging consistent with bilateral synovitis (4,108). 

In 75 children with typhoid fever, aged under 6 years (mean age 32 months), ciprofloxacin had no adverse effects on growth or joints (54). In another study only 2 of 219 children treated with ciprofloxacin developed arthropathy, in one case transiently (55). In a necropsy study on children treated with ciprofloxacin 20 0 mg/kg/day for an average of 148 days, there were no chondrotoxic effects however, synovial membranes showed signs of subacute synovitis, which had not been noted in life (56). 

Foreign-body reactions to silicone can complicate silicone elastomer joint prostheses, manifesting as synovitis and/or lymphadenopathy, sometimes at remote locations (27). 

---