The so-called synovitis is inflammation of human synovial tissue. According to different types of inflammation, it can be divided into infectious synovitis and aseptic synovitis. Infectious synovitis is often accompanied by obvious systemic symptoms, which is easy to diagnose and can usually be cured.
What we usually call synovitis often refers to aseptic synovitis. The most common synovitis in clinic is knee joint, followed by hip joint and ankle joint synovitis.
Aseptic synovitis does not need antibiotics!
Because aseptic synovitis is synovitis without bacterial infection. Although there is no bacterial infection, its symptoms also have inflammatory characteristics such as redness, swelling, heat and pain, so we also call it acute synovitis or acute attack of synovitis.
Acute synovitis can often be cured without sequelae through active treatment. If not treated in time, it will turn into chronic synovitis, which often recurs, affecting sports ability and reducing quality of life.
2. Why is synovium inflamed? According to different ages, the causes of synovitis are different:
Young synovitis:
Young people's knee synovitis is mainly caused by knee sprain and various intra-articular injuries, such as meniscus injury, synovial injury, cruciate ligament or lateral collateral ligament injury; Intra-articular effusion or sometimes hematocele manifests as acute traumatic synovitis of the knee joint. Another reason is that diseases such as rheumatism, rheumatoid arthritis or ankylosing spondylitis invade the synovium of joints, causing acute synovitis, or persisting in it will eventually turn into chronic synovitis.
Synovitis in the elderly:
Synovitis of knee joint is secondary to osteoarthritis of knee joint in the elderly, which is mainly mechanical and biochemical stimulation caused by cartilage degeneration and hyperosteogeny (bone spur), followed by synovial edema, exudation and effusion of knee joint.
Synovitis in children:
Children's synovitis usually occurs after climbing a mountain or catching a cold and having a fever. Children usually do a lot of exercise when walking for a short time or a long time, which is the reason for climbing mountains. Some children also fall and sprain.
Excessive exercise:
Common patients who have been inactive for a long time suddenly take part in long-distance running such as mountaineering or marathon, or go out for a long walk, and the amount of exercise increases. The joint swelling type is mainly swelling after excessive exercise, and the degree of pain is different.
3. What are the symptoms of synovitis? There is no age limit for synovitis of knee joint, and it can occur at any age.
For young people:
They usually do a lot of exercise, so they are prone to swelling, pain, difficulty in moving, limping when walking, high local skin temperature, skin swelling and tension or blood puncture from joints during exercise.
Old people usually have chronic synovitis:
Joint pain, obvious swelling, obvious going up and down stairs, stiff and inflexible, and creaking when flowing. Symptoms of children's synovitis, children's onset site is mostly in the hip joint, children will feel pain when sitting, lying, exercising and walking; There will be a phenomenon of tiptoe (limping); The onset time is mostly after a cold, so it is difficult for early parents to find or misdiagnose it.
(1) Symptoms are mild. Mainly joint pain, joint swelling is not obvious or accompanied by mild swelling, creaking when walking, joint pain or discomfort when going up and down stairs or exerting force; After walking for a long time, the joints feel hot and stiff, and the pain is aggravated.
(2) The symptoms are moderate. Joint swelling, joint cavity effusion, no obvious pain, discomfort when squatting or bending, muscle atrophy in some patients, swelling after excessive exercise. Symptoms are mild in the morning and aggravated at night; You can't walk for long. If you walk too much, your calf will feel pain and water will increase.
(3) Severe symptoms. Joint swelling and pain is obvious, accompanied by effusion, bone spur and free bone.
4. How to treat synovitis? There is no doubt that most synovitis can be cured. Usually, synovitis refers to aseptic synovitis, and antibiotics (penicillin, cephalosporin, clindamycin, etc.) are ineffective. ) to diminish inflammation of this synovitis.
For this kind of patients, what is really needed is another kind of non-steroidal anti-inflammatory drugs, which often have analgesic effect and are an indispensable scheme in the treatment process. By eliminating the inflammation of joint cavity and synovium, the analgesic effect can be achieved, and the joint swelling can be reduced at the same time.
Treatment of aseptic synovitis can be roughly divided into the following three types:
(1) drug therapy: At present, non-steroidal anti-inflammatory and analgesic drugs are the main therapeutic drugs, which are mainly divided into oral and external use. Topical drugs are all anti-inflammatory and analgesic drugs, which have limited therapeutic effect on chronic synovial inflammation or acute severe trauma. The mechanism of action of internal medicine is similar to that of external medicine, which can relieve discomfort symptoms such as pain.
(2) Joint cavity effusion extraction (not recommended): The main purpose is to relieve the pressure in the joint cavity and improve the symptoms of joint swelling and pain and limited flexion and extension, which is suitable for patients with large joint cavity effusion (aseptic requirements must be strictly implemented during the operation to prevent joint infection). For joint cavity effusion, a small amount of effusion can be absorbed by itself;
(3) intra-articular injection therapy:? Including closed needle, sodium hyaluronate injection, etc. This is usually carried out in conjunction with the aspiration treatment of joint cavity effusion. Firstly, the joint cavity effusion is sucked as clean as possible, then the sealing needle or sodium hyaluronate injection is directly injected into the joint cavity, and then the joint cavity is properly bandaged with elastic bandage.
(4) Eliminate stimulating factors and avoid synovitis: For synovitis caused by acute injury, it is necessary to stop the joints for 2-3 weeks, and at the same time avoid joint cold, avoid acute exercise and reduce walking distance. Children with synovitis can also be properly dragged by skin.
(5) Surgical treatment: For young patients with synovitis caused by rheumatoid arthritis, ankylosing spondylitis, villonodular synovitis, if necessary, consider surgical removal of synovium to avoid further invasion of articular cartilage and bone tissue.
For the elderly, in patients with severe synovitis caused by hyperosteogeny, secondary osteoarthritis or improper treatment of other medical diseases (the most common is rheumatoid), besides synovitis, the main problem is the wear or erosion of articular cartilage surface, and simple synovial cleaning and resection can not fundamentally solve the problem. Total knee replacement is preferred at this time.
When replacing artificial joint prosthesis with diseased articular surface, the inflammatory synovial tissue in the joint cavity should be completely removed to ensure that there will be no inflammatory effusion (bloody effusion in the joint cavity after operation). Combined with professional and standardized individualized postoperative rehabilitation training plan, patients can basically return to normal or close to normal life.
5. How to prevent synovitis? (1) Avoid knee joint overactivity and strain.
Pay attention to the combination of work and rest and exercise properly. Long-term, excessive and strenuous exercise or activity is one of the basic reasons for synovial degeneration, especially for weight-bearing joints (such as knee joint and hip joint), excessive exercise increases the stress and wear of joint surface. Proper exercise, especially joint exercise, can increase the pressure in the joint cavity, which is beneficial to the infiltration of joint fluid into cartilage and alleviate the degenerative changes of articular cartilage, thus reducing or preventing synovitis.
(2) Control weight
Obese people should properly control their diet, pay attention to adjusting their diet structure, reduce calorie intake, control their weight within an appropriate range, reduce the pressure and wear on joints, and prevent joint synovitis.
(3) Pay attention to keep warm
Avoid catching cold. Pay attention to adjust your clothes, protect your knee joints that are prone to synovitis, stop craving air conditioning, and pay more attention to exercise at ordinary times to better prevent synovitis. If necessary, you can wear knee pads to keep warm and protect your joints.
(4) Reasonable diet
Avoiding excessive intake of acidic substances, acid-base balance of diet is very important for the treatment of synovitis and the prevention and treatment of complications. The elderly can properly supplement calcium, vitamin D and other drugs closely related to bone metabolism joints, and at the same time carry out moderate physical exercise to slow down the aging and degeneration of bone tissue.