SYNOVITIS [synovitis; lat. (membrana) of synovialis a synovial membrane + - itis)] — the inflammation of a synovial membrane limited to its limits and which is characterized by accumulation of an exudate in the cavity covered by it (in a synovial bag, a vagina of sinews, a joint cavity). Are surprised more often joints (see) — knee, elbow, radiocarpal, talocrural. The page develops preferential in one joint, is more rare at the same time in several joints (see. Polyarthritis ).
On etiologies Pages divide on infectious and aseptic. Pathogenic microorganisms, defiant nonspecific (staphylococcus, streptococci, pneumococci, etc.) and specific (tubercular mycobacteria, etc.) inflammatory processes can be infectious S.' cause in to a synovial membrane (see) where they get from the environment through wounds in the contact, hematogenous or lymphogenous way from inf. the centers in an organism. Aseptic S. most often develop at a repeated mechanical injury of a joint (so-called reactive S.), and also at hemophilia, endocrine disturbances, disbolism, etc. The considerable group is made by the allergic S. resulting from action allergens (see) infectious and noninfectious character on fabric of a synovial membrane at her hypersensitivity to them (see. Allergy ).
On a wedge, to a current nonspecific S. happen acute and chronic, on character exudate (see) — serous, hemorrhagic, serofibrinous (adhesive) and purulent.
Pathoanatomical changes at acute nonspecific S. are characterized by a hyperemia, puffiness of a synovial membrane and its thickening. At more intensive and long influence of an irritant in a joint cavity the exudate in the form of yellowish color of exudate with flakes of fibrin (serous or seroznofibrinozny S.) is formed. The surface of a synovial membrane takes a wavy, velvety form, its vorsina are increased. At microscopic examination dystrophy of sinoviotsit comes to light, vessels of a synovial membrane are expanded, overflowed with blood, their walls are loosened. The fabric of a synovial membrane which is especially located perivaskulyarno, the razvo-loknena which bulked up with sites of homogenization, an infiltrirovan cellular elements. At hemorrhagic S. the limited or diffusion hyperplasia of a synovial membrane is observed, in a stroma histiocytes are found (see), is more often with adjournment of hemosiderin, ksantomny or multinuclear colossal cells (see). Purulent S. develops as a result of serous, serofibrinous, hemorrhagic S. or arises initially. Pathoanatomical changes at purulent S. are expressed much more sharply, than at serous or serofibrinous. Changes of walls of vessels and a plentiful exit in surrounding fabrics of leukocytes and fibrin, sometimes blood are especially characteristic of purulent S.; in the latter case in the fabrics impregnated with pus separate hemorrhages are formed. Purulent fusion of fabrics and death of structural elements of a synovial membrane is observed.
Upon acute S.'s transition in hron. a form or at hron. S.'s current development of fibrosis, a thickening of a fibrous membrane of the joint capsule is noted. At so-called chronic fleecy S. giperplaziro-bathing vorsina of a synovial membrane, as well as vorsinopodobiy organized imposings of fibrin, in the form of brushes hang down in a joint cavity, and otshnurovyvayas, form the «rice little bodies» called so because of their external looking alike grains of rice. According to I. P. Aleksinsky, increase morfol. changes and a wedge, manifestations at chronic S. it is connected not so much with inflammatory process how many with disturbance krovo-and lymphokineses in the joint capsule as a result of its fibrous regeneration.
Clinically acute serous nonspecific S. is shown by change of a shape of a joint, a smoothness of its contours, temperature increase, morbidity at a palpation, emergence in a joint cavity of an exudate, to-ry especially well comes to light in a knee joint balloting of a patella (see. Balloting ). The movements in a joint are limited, painful. Weakness, an indisposition, moderate fervescence, acceleration of ROE is noted.
At purulent S. symptoms of a disease are expressed more sharply, than at serous. The serious general condition of the patient (sharp weakness, a fever, high temperature of a body, sometimes nonsense) is characteristic. Contours of a joint are maleficiated, erubescence in a joint, morbidity, restriction of movements, a contracture is observed (see). Quite often the phenomena regional are found lymphadenitis (see). In nek-ry cases of purulent S. process extends to a fibrous membrane of the joint capsule with development of purulent arthritis (see. Arthritises ) and on the fabrics surrounding a joint (see. Periarthritis , Phlegmon ). At the same time the area of a joint is considerably increased, fabrics of a pastozna, skin on joints is sharply hyperemic, shines. If bones, cartilages and the copular device of a joint are involved in process, develops panarthritis (see). Undertreated acute S. can recur.
In an initial stage of chronic serous S. clinical manifestations are expressed poorly. Patients complain of bystry fatigue, fatigue during the walking, insignificant restriction of movements in a sore joint, existence of the aching pains. In a joint cavity the plentiful exudate accumulates, the so-called hydroarthrosis develops (see. Hydrarthrosis ), at long existence the cut occurs sprain of a joint that results in his looseness, an incomplete dislocation and even to dislocation (see).
S.'s diagnosis is made on the basis of results by a wedge, inspections and punctures, data of cytologic and bacteriological researches of exudate, and also specific serological tests. In case of secondary S. it is necessary to reveal the basic disease which served as its reason.
Treatment acute serous S. begin with an immobilization of an extremity with the plaster tire (see. Plaster equipment ). In initial stages of S. apply UVCh-therapy (see), UF-ob-lucheniye in erythema doses (see. Ultraviolet radiation ), an electrophoresis with novocaine (see the Electrophoresis, medicinal), the warming compresses from 10 — 20% solution of Dimexidum. At a persistent current appoint an electrophoresis with potassium iodide, lidazy, fonoforez with a hydrocortisone (see. Ultrasonic therapy ), paraffin therapy (see), mud cure (see). In case of a considerable exudate punctures of a joint and introduction of antibiotics (to the Crimea microflora of the center is sensitive) as in a joint cavity, and intramusculary are shown. In case of an easy current of S. it is possible to be limited to hard bandaging of a joint, an immobilization of an extremity (before complete elimination of an exudate in a joint cavity and inflammatory changes in para-articular fabrics) and physiotherapeutic procedures.
At purulent S.'s treatment the immobilization of a sore extremity by means of the plaster tire or a bandage and an intensive local and general antibioticotherapia is especially important. After removal of purulent exudate during a puncture enter antibiotics of a broad spectrum of activity, a hydrocortisone with solution of novocaine into a joint cavity. Effectively long drop washing of a joint cavity weak solution of antibiotics through two needles or thin polyethylene tubes. At a heavy current are shown arthrotomy (see) and drainage of a joint cavity (see. Drainage ).
At chronic serous or serofibrinous S.'s treatment punctures of a joint are necessary rest, physiotherapeutic procedures (electrization, paraffin applications, mud cure, etc.), and also identification and therapy of the basic disease which served as the reason of development of chronic S. V the started cases sometimes apply operational treatment (see. Synovectomy ).
Forecast at S. depends on a condition of an organism and virulence of microflora, and also on timely and correct treatment. Along with the absolute recovery (preservation of movements in a joint) which more often is observed at a serous p allergic S. development of rigidity or a full immovability in a joint is possible. At a heavy current of acute purulent S. the threat for life of the patient in connection with development is quite often created sepsis (see).
From specific inflammatory processes in a synovial membrane of others tubercular and syphilitic defeats meet more often (see Tuberculosis extra pulmonary, Syphilis).
Bibliography: Grigoryan A. V., GOST and shch e in V. K. and To about with t and to about in B. A. Purulent diseases of a brush, M., 1978; Koshelev V. K. and Podgorod-nichenko V. K. Clinical features of a pseudorheumatism depending on versions of the immunological status, Rubbed. arkh., t. 50, No. 9, page 60, 1978; Mironova 3. Page, etc. Experience of treatment of damages and diseases of a knee joint at athletes, Ortop. and herbs mats., N ° 7, page 7, 1980; Pavlov V. P. Complex surgical treatment of infectious nonspecific polyarthritis, M., 1977; Pavlova V. N. Synovial environment of joints, M., 1980;
Rusakova M. S. and Surovtsev V. M. Kliniko-morfologichesky options of a pseudorheumatism at teenagers, Rubbed. arkh., t. 50, No. 9, page 44, 1978.
F. R. Bogdanov, I. I. Talko.