Abstract
Etymologically, the word synovitis generally refers to acute or chronic inflammation of the synovial membrane. Today, however, the term is used to refer to a disease process (not necessarily inflammatory) that may originate from the synovial membrane and involve the structures of the joint. Synovitis can have different causes: traumatic, autoimmune, infectious, dysmetabolic or neoplastic, and it is typically characterised by the presence of varying degrees of swelling, pain, redness, heat and functional impairment. The knee is a frequent target of this disease, and it is the joint most likely to be affected by special forms of synovitis such as pigmented villonodular synovitis and synovial chondromatosis. Inflammatory and degenerative joint diseases are usually diagnosed on the basis of clinical and imaging data. However, these data are not always sufficient, especially in the event of a monoarticular onset; in such cases, the use of histopathology and a synovitis score will increase the diagnostic accuracy. There exist various histological scoring systems for synovitis, and the one proposed by Krenn, which is essentially applicable to all forms of synovitis, is the most commonly used. It is a numerical scoring system based on semi-quantitative grading of three key features of synovitis: enlargement of the lining cell layer, activation of stromal cells (as shown by the cellular density of the synovial stroma) and leukocytic infiltration. Each of these three components is assigned a score from 0 to 3, resulting in an overall score of between 0 and 9. Through the analysis of numerous large samples, mean Krenn scores have been established for normality (1.0), post-traumatic arthritis (2.0), osteoarthritis (2.0), psoriatic arthritis (3.5), reactive arthritis (5.0) and rheumatoid arthritis (5.0) [15]. A strong correlation has since emerged between the synovitis score, immunohistochemistry findings (Ki-67, CD68) and the clinical severity of the disease [7, 26]. The use of the synovitis score has proved to be useful in defining forms lacking the typical histological features, allowing them to be distinguished on the basis of the intensity and severity of the synovial inflammation.
Keywords
- Synovial Membrane
- Psoriatic Arthritis
- Osteochondritis Dissecans
- Haemosiderin Deposit
- Synovial Chondromatosis
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References
Aurégan J, Klouche S, Bohu Y, et al. Treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 2014;30(10):1327–41.
Bertoni F, Unni K, Beabout JW, et al. Chondrosarcomas of the synovium. Cancer. 1991;67(1):155–62.
Boyle DL, Rosengren S, Bugbee W, et al. Quantitative biomarker analysis of synovial gene expression by real-time PCR. Arthritis Res Ther. 2003;5(6):R352–60.
Byers PD, Cotton RE, Deacon OW. The diagnosis and treatment of pigmented villonodular synovitis. J Bone Joint Surg Br. 1968;50:290–305.
Chin KR, Barr SJ, Winalski C, et al. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am. 2002;84:2192–202.
Colman MW, Ye J, Weis KR, et al. Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates? Clin Orthop Relat Res. 2013;471(3):883–90.
Della Beffa C, Slansky E, Pommerenke C, et al. The relative composition of the inflammatory infiltrate as an additional tool for synovial tissue classification. PLoS One. 2013;8(8):e72494.
Dines JS, DeBerardino TM, Wells JL, et al. Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee. Arthroscopy. 2007;23:930–7.
Flandry FC, Hughston JC, Jacobson KE, et al. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 1994;300:183–92.
Fletcher JA, Henkle C, Atkins L, et al. Trisomy 5 and trisomy 7 are nonrandom aberrations in pigmented villonodular synovitis: confirmation of trisomy 7 in uncultured cells. Genes Chromosomes Cancer. 1992;4(3):264–6.
Gerlag DM, Tak PP. How to perform and analyse synovial biopsies. Best Pract Res Clin Rheumatol. 2013;27(2):195–207.
Hallam P, Ashwood N, Cobb J. Malignant transformation in synovial chondromatosis of the knee? Knee. 2001;8(3):239–42.
Isart A, Gelber PE, Besalduch M, et al. High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis. Rev Esp Cir Orthop Traumatol. 2015;59(6):400–5.
Klareskog L, Padyukov L, Alfredsson L. Smoking as a trigger for inflammatory rheumatic diseases. Curr Opin Rheumatol. 2007;19(1):49–54.
Krenn V, Morawietz L, Burmester GR, et al. Synovitis score: discrimination between chronic low-grade and high-grade synovitis. Histopathology. 2006;49(4):358–64.
Kuzmanova SI, Atanassov AN, Andreev SA, et al. Minor and major complications of arthroscopic synovectomy of the knee joint performed by rheumatologist. Folia Med. 2003;45(3):55–9.
Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001;358(9285):903–11.
Lu KH. Subcutaneous pigmented villonodular synovitis caused by portal contamination during knee arthroscopy and open synovectomy. Arthroscopy. 2004;20(4):e9–13.
McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol. 2007;7(6):429–42.
Mertens F, Jonsson K, Willén H, et al. Chromosome rearrangements in synovial chondromatous lesions. Br J Cancer. 1996;74(2):251–4.
Milgram JW. Synovial osteochondromatosis: a histopathological study of thirty cases. J Bone Joint Surg Am. 1977;59(6):792–801.
Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223.
Myers BW, Masi AT. Pigmented villonodular synovitis and tenosynovitis: a clinical epidemiologic study of 166 cases and literature review. Medicine. 1980;59(3):223–38.
Neame RL, Carr AJ, Muir K, et al. UK community prevalence of knee chondrocalcinosis: evidence that correlation with osteoarthritis is through a shared association with osteophyte. Ann Rheum Dis. 2003;62(6):513–8.
O’Connell JX. Pathology of the synovium. Am J Clin Pathol. 2000;114(5):773–84.
Pessler F, Ogdie A, Diaz-Torne C, et al. Subintimal Ki-67 as a synovial tissue biomarker for inflammatory arthropathies. Ann Rheum Dis. 2008;67:162–7.
Reece RJ, Canete JD, Parsons WJ, et al. Distinct vascular patterns of early synovitis in psoriatic, reactive, and rheumatoid arthritis. Semin Arthritis Rheum. 1999;42(7):1481–4.
Rodriguez-Merchan EC. Review article: open versus arthroscopic synovectomy for pigmented villonodular synovitis of the knee. J Orthop Surg (Hong Kong). 2014;22(3):406–8.
Schett G. Cells of the synovium in rheumatoid arthritis. Osteoclasts Arthritis Res Ther. 2007;9(1):203.
Sciot R, Dal Cin P, Bellemans J, et al. Synovial chondromatosis: clonal chromosome changes provide further evidence for a neoplastic disorder. Virchows Arch. 1998;433(2):189–91.
Sharma V, Cheng EY. Outcomes after excision of pigmented villonodular synovitis of the knee. Clin Orthop Relat Res. 2009;467:2852–8.
Weckauf H, Helmchen B, Hinz U, et al. Expression of cell cycle-related gene products in different forms of primary versus recurrent PVNS. Cancer Lett. 2004;210(1):111–8.
Weyand CM, Hicok KC, Conn DL. The influence of HLA-DRB1 genes on disease severity in rheumatoid arthritis. Ann Intern Med. 1992;117(10):801–6.
Wuisman PI, Noorda RJ, Jutte PC. Chondrosarcoma secondary to synovial chondromatosis. Report of two cases and a review of the literature. Arch Orthop Trauma Surg. 1997;116(5):307–11.
Yang B, Liu D, Lin J, et al. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015;37(2):234–9.
Zvijac JE, Lau AC, Hechtman KS, et al. Arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 1999;15:613–7.
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Berruto, M. et al. (2016). Synovitis of the Knee. In: Randelli, P., Dejour, D., van Dijk, C., Denti, M., Seil, R. (eds) Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49376-2_29
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