The Musculoskeletal System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Basic treatment of rheumatoid arthritis involves rest (splinting), passive exercise and heat, and emotional support. Anti-inflammatory and analgesic agents are used for pain and management of inflammation. If this is not sufficient, goldsalts, methotrexate, antimalarial drugs, penicillamine, azathioprine, or corticosteroids may be effective. Surgical procedures include joint replacement and synovectomy.
Rheumatologie Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
If an inflamed RA knee develops a large effusion that becomes chronic, a popliteal or Baker’s cyst may develop. Most of the time, the communication between the joint space and the cyst is one-way and this valve effect can cause high pressures in the popliteal space. Because fluid is incompressible, a rupture of the cyst can occur. The release of a large volume of fluid that contains inflammatory mediators posteriorly between the medial head of the gastrocnemius muscle and the tendinous insertion of the biceps femoris muscle can cause the affected calf to become swollen, red, and intensely painful. The patient thus involved can present to the physician with a problem that resembles acute thrombophlebitis. The Homen’s sign is frequently positive, thus causing some confusion. A positive arthrogram (with or without a negative venogram, depending on the circumstances) can establish the presence or absence of a Baker’s cyst. Treatment with intraarticular steroids, rest, elevation, and attention to the underlying rheumatological conditions should be effective in the vast majority of cases. Surgical synovectomy may occasionally be necessary. A word of caution: treating a patient with a Baker’s cyst using an intravenous anticoagulant, like heparin (the preferred treatment for acute thrombophlebitis), is not only ineffective, but may be counterproductive, causing painful ecchymoses in the calf tissues that have become hyperemic from the inflammation.
Klippel–Trenaunay syndrome: Pain and psychosocial considerations
Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic in Vascular Malformations, 2019
Arthritis occurs in a small number of patients with KTS, but in those patients, it is a major problem. Usually it involves the knee but can also involve the ankle. Destruction of cartilage occurs likely from recurrent hemarthrosis when the vascular malformation is within a joint. The presence of the vascular malformation may create a chronic synovitis. Patients typically try to limit pain by flexing the knee and can develop a flexion contracture (Figure 84.3). Treatment includes analgesics and maneuvers to prevent the flexion contracture. This may involve physical therapy, passive stretching, and bracing. Synovectomy may be useful. If the flexion contracture is severe enough to prevent walking and the leg cannot be straightened, amputation may be necessary to control the pain and allow the patient to walk with a prosthesis.
Hemophilic arthropathy: current treatment challenges and future prospects
Published in Expert Opinion on Orphan Drugs, 2018
The best treatment for synovitis is synovectomy. Synovectomy can be of two basic types: radiosynovectomy and arthroscopic synovectomy [9,24]. Both are equally effective in alleviating the problem, although radiosynovectomy has a cost of approximately 2,500 euros in factor expenses, whereas arthroscopic synovectomy costs 10 times more (25,000 euros in factor expenses). In addition, arthroscopic synovectomy is a surgical procedure that requires general anesthesia and hospital admission. Radiosynovectomy is performed on an outpatient basis in the Department of Nuclear Medicine with the help of specialists who prepare the isotopes to be injected into the affected joint. In our center, we use yttrium-90 for knees and rhenium-186 for elbows and ankles at minimum radiation doses (Table 1). In addition, the isotope is always injected inside the joint, which is verified by a postinjection scintigraphy (Figure 4). Radiosynovectomy can be repeated up to two times a year as many times as appropriate. We indicate it when the patient has had two or more hemarthroses in the previous 6 months. After a radiosynovectomy, the average decrease in recurrent hemorrhages is 65% [24,25].
Bone change after surgical treatment of mucous cyst at the interphalangeal joint of the great toe in a patient with rheumatoid arthritis
Published in Modern Rheumatology, 2019
Rie Kurose, Dai Tanaka, Yasuyuki Ishibashi
On pathological examination, synovitis was not so strong, namely whether mucous cyst in our case was associated with synovitis has been still unknown. However, there are recent reports describing synovectomy for finger joints in patients with RA before bone changes occur contributes to slowing down of the progression of bone changes [10,11]. Synovectomy for finger joints is the recommended surgery when chronic synovitis of the finger joints does not respond to any other conservative treatment. Although she could not take medication for RA because of the renal dysfunction, bone erosion healing was shown after the synovectomy and the disease activity of RA has also improved. In cases of mucous cyst complicated with RA, a combination of synovectomy with surgical treatment of mucous cyst might be effective and recommended.
Hemophilic arthropathy: a teaching approach devoted to hemophilia treaters in under-development countries
Published in Expert Review of Hematology, 2021
Synovitis can be treated by means of radiosynovectomy, open surgical synovectomy or arthroscopic synovectomy [15,20]. Surgical synovectomy was for the first time performed in Italy in 1968 by Storti and further carried on routinely in several Italian hemophiliacs by Traldi for many years. Although the frequency of bleeding decreased, the joint function of the joint evolved toward ankylosis in a few years [21]. All types of synovectomy are efficacious in relieving the situation; however, radiosynovectomy has a cost of approximately 2,500 euros in factor expenditures, whereas open synovectomy and arthroscopic synovectomy costs 10 times more (25,000 euros in factor expenditures). Also, arthroscopic synovectomy is a surgical technique that needs general anesthesia and hospitalization.
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