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Monoarticular synovitis of knee: dealing with the dilemma

Introduction: Chronic synovitis involving a single large joint remains a diagnostic dilemma. We present 61 cases of chronic synovitis of the knee, followed prospectively for 2 years. The study focuses on the diagnosis, management, and histopathological correlation. Methods: We prospectively studied...

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Autores principales: Goyal, Tarun, Paul, Souvik, Kundu Choudhury, Arghya, Kalonia, Tushar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731910/
https://www.ncbi.nlm.nih.gov/pubmed/33306021
http://dx.doi.org/10.1051/sicotj/2020044
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author Goyal, Tarun
Paul, Souvik
Kundu Choudhury, Arghya
Kalonia, Tushar
author_facet Goyal, Tarun
Paul, Souvik
Kundu Choudhury, Arghya
Kalonia, Tushar
author_sort Goyal, Tarun
collection PubMed
description Introduction: Chronic synovitis involving a single large joint remains a diagnostic dilemma. We present 61 cases of chronic synovitis of the knee, followed prospectively for 2 years. The study focuses on the diagnosis, management, and histopathological correlation. Methods: We prospectively studied 61 patients with chronic mono-articular synovitis of the knee joint, between July 2016 and September 2017. All patients underwent plain radiographs, magnetic resonance imaging, and arthroscopic examination with synovial biopsy. Further treatment was based on findings of histopathological examination. Results: The average duration of symptoms was 7.72 ± 4.34 months. The mean age at presentation was 29.93 ± 15.56 years. Results of histopathological examination showed chronic nonspecific inflammation in 28 patients (46%), features suggesting tubercular infection in 19 patients (31%), pigmented villonodular synovitis in seven patients (11.5%), rheumatoid arthritis in three (5%) patients, acute inflammation in three (5%) patients and findings suggestive of synovial chondromatosis in one (1.5%) patient. Treatment was based on histopathological results. Intra-articular injections of methylprednisolone (80 mg depot preparation) were given to all patients with nonspecific synovitis and rheumatoid arthritis. Anti-tubercular treatment was started for patients with tubercular synovitis. Complete arthroscopic/open synovectomy followed by radiotherapy was carried out for patients with pigmented villonodular synovitis. Non-steroidal anti-inflammatory drugs are used for patients with acute on chronic inflammation. All patients had symptomatic relief and functional improvement in further follow-up. Discussion: Histopathological reporting remains the mainstay for diagnosis. The various differentials should always be kept in mind when approaching patients with chronic mono-articular synovitis. Specific treatment can be started once the diagnosis is confirmed.
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spelling pubmed-77319102020-12-18 Monoarticular synovitis of knee: dealing with the dilemma Goyal, Tarun Paul, Souvik Kundu Choudhury, Arghya Kalonia, Tushar SICOT J Original Article Introduction: Chronic synovitis involving a single large joint remains a diagnostic dilemma. We present 61 cases of chronic synovitis of the knee, followed prospectively for 2 years. The study focuses on the diagnosis, management, and histopathological correlation. Methods: We prospectively studied 61 patients with chronic mono-articular synovitis of the knee joint, between July 2016 and September 2017. All patients underwent plain radiographs, magnetic resonance imaging, and arthroscopic examination with synovial biopsy. Further treatment was based on findings of histopathological examination. Results: The average duration of symptoms was 7.72 ± 4.34 months. The mean age at presentation was 29.93 ± 15.56 years. Results of histopathological examination showed chronic nonspecific inflammation in 28 patients (46%), features suggesting tubercular infection in 19 patients (31%), pigmented villonodular synovitis in seven patients (11.5%), rheumatoid arthritis in three (5%) patients, acute inflammation in three (5%) patients and findings suggestive of synovial chondromatosis in one (1.5%) patient. Treatment was based on histopathological results. Intra-articular injections of methylprednisolone (80 mg depot preparation) were given to all patients with nonspecific synovitis and rheumatoid arthritis. Anti-tubercular treatment was started for patients with tubercular synovitis. Complete arthroscopic/open synovectomy followed by radiotherapy was carried out for patients with pigmented villonodular synovitis. Non-steroidal anti-inflammatory drugs are used for patients with acute on chronic inflammation. All patients had symptomatic relief and functional improvement in further follow-up. Discussion: Histopathological reporting remains the mainstay for diagnosis. The various differentials should always be kept in mind when approaching patients with chronic mono-articular synovitis. Specific treatment can be started once the diagnosis is confirmed. EDP Sciences 2020-12-11 /pmc/articles/PMC7731910/ /pubmed/33306021 http://dx.doi.org/10.1051/sicotj/2020044 Text en © The Authors, published by EDP Sciences, 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Goyal, Tarun
Paul, Souvik
Kundu Choudhury, Arghya
Kalonia, Tushar
Monoarticular synovitis of knee: dealing with the dilemma
title Monoarticular synovitis of knee: dealing with the dilemma
title_full Monoarticular synovitis of knee: dealing with the dilemma
title_fullStr Monoarticular synovitis of knee: dealing with the dilemma
title_full_unstemmed Monoarticular synovitis of knee: dealing with the dilemma
title_short Monoarticular synovitis of knee: dealing with the dilemma
title_sort monoarticular synovitis of knee: dealing with the dilemma
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731910/
https://www.ncbi.nlm.nih.gov/pubmed/33306021
http://dx.doi.org/10.1051/sicotj/2020044
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