Synovitis is a painful and, occasionally, disabling disease. Patients with
synovitis, especially new onset
synovitis, should be referred to a rheumatologist urgently so that they can be assed and treated as quickly as possible. Clinical assessment and investigations are required to help differentiate between transient (< 3 months) and persistent (> 3 months)
synovitis. This differentiation is important, as persistent
synovitis can lead to joint damage and disability.
Septic arthritis is a rheumatological emergency requiring immediate assessment and specific treatment. The earlier
synovitis is treated, the more effective treatment is likely to be. If treated very early, there is potential to prevent the move from transient to persistent
synovitis. Transient
synovitis can be treated with painkillers,
NSAIDs and/or
corticosteroids, depending on severity. Persistent
synovitis may also require disease-modifying drugs. Clinical indicators of persistence include symptom duration at first visit, early morning stiffness for > 1 h,
arthritis in more than three joints, bilateral compression
pain in metatarsophalangeal joints,
rheumatoid factor positivity, anti-
cyclic citrullinated peptide antibody positivity, erosions on hand or feet X-rays and a family history of
rheumatoid arthritis. Disease-modifying drugs need to be considered early to achieve clinical remission before damage and disability occur. Despite emerging new treatments for
synovitis, especially persistent
synovitis, full clinical remission is still not achieved in most patients, and more research into disease processes and targeted
therapies is required.