Knee Synovitis | Synovial inflammation of the knee

Dr. David Woznica ProlotherapistDavid N. Woznica, MD

In this article we will examine synovial inflammation of the knee as a result of knee instability and osteoarthritis and discuss treatment options.

  • The synovial fluid is a thick gel-like liquid that helps cushion the knee and acts to absorb the daily impact of walking and running and stair climbing our knees are subjected to.
  • The synovial membrane lines the joint capsule and helps maintain synovial fluid in joints.
  • Inflammation of the synovial membrane, synovitis, is found in both rheumatoid and osteoarthritis patients. It can also develop after knee surgery.
  • Doctors use synovial fluid as a means to understand the inflammatory environment of the knee.
  • Before you read on, do you have questions about Synovial inflammation of the knee? You can get help and information from our Caring Medical staff

Many of you will be reading this article because you are looking for ways to treat your Synovitis

Typically the first line of treatment will include the use of anti-inflammatory drugs. The list includes:

  • Most common : aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • Prescriptions: celecoxib, diclofenac indomethacin, oxaprozin (Daypro), piroxicam (Feldene)

NSAID-resistant ongoing osteoarthritis pain

Obviously an anti-inflammatory medication is designed to reduce pain and pressure produced by inflammation. In our article When Non-Steroidal Anti-Inflammatories (NSAIDs) make pain worse, Ross Hauser, MD cites research against the use of NSAIDs:

From medical journal Pain. In this statement doctors suggest that the reason joint replacement is recommended and performed is because NSAIDs do not work.

“Difficulty in managing advanced osteoarthritis pain often results in joint replacement therapy. Improved understanding of mechanisms driving NSAID-resistant ongoing osteoarthritis pain might facilitate development of alternatives to joint replacement therapy.”(1)

Please note the keywords: NSAID-resistant ongoing osteoarthritis pain

You may be recommended a cortisone injection

Over the years we have seen many patients who have received corticosteroid (cortisone) injections for joint pain. Unfortunately for many, excessive cortisone treatments lead to a worsening of  chronic pain.

  • Corticosteroid damaged knee cartilage and provided no significant pain relief after two years.

In 2017, doctors from Tufts Medical Center in Boston, asked “What are the effects of intra-articular injection of 40 mg of triamcinolone acetonide (corticosteroid injection) given every 3 months on progression of cartilage loss and knee pain in patients with osteoarthritis?”

Writing in the Journal of the American Medical Association, (JAMA) they published their answer:

“Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.”(2)

RICE and ICE

You may be recommended to the use of ice to reduce the swelling.

For many athletes a doctor’s recommendation of the RICE protocol for healing their sports related soft tissue issue injury was seen as the gold standard of care. However, this treatment is now under criticism from a surprising source, the doctor who created the RICE treatment guidelines, Gabe Mirkin, MD.

In a recent article on his own website, Dr. Mirkin admits that both ice and rest (key components of RICE) may delay healing. This insight comes nearly 40 years after Dr. Mirkin authored the The Sportsmedicine Book (1978), where he coined the acronym RICE for the 4 elements which became the standard of care in treating soft tissue injuries- Rest, Ice, Compression and Elevation. Coaches, physicians, physical therapists and the lay public have recommended and followed the “RICE” guidelines for decades, but as Mirkin states:

  • “it now appears that both ice and complete rest may delay healing, instead of helping.”(3)

If all these treatments do not work, and the inflammation continues and causes damage to the knee, surgical removal of the inflamed tissue, ultimately a knee replacement may be recommended.

Understanding inflammation is how you can help your knee

To understand your inflammation is to understand that your knee is or has become unstable. Inflammation is a healing mechanism trying to repair damage.

Research is busy asking the question, what comes first, the inflammation or the arthritis? On the surface that seems pretty straight forward, inflammation and degeneration causes arthritis. But not so fast –

Doctors at the University of Calgary, publishing in the medical journal Osteoarthritis and Cartilage, suggest that  knee joint instability leads to destructive alterations in  the synovial membranes and cartilage. So in this research the knee instability came first, then inflammation, then osteoarthritis.

Therefore to treat synovial inflammation – you must treat knee instability

Their research conclusion was that knee joint instability may promote an inflammatory intra-articular milieu (a diseased joint environment), thereby contributing to the development of osteoarthritis.(4Please see our article Chronic Knee Pain, Knee Instability, and Degenerative Knee Disease for a more detailed discussion.

How to treat knee instability and synovitis – Platelet Rich Plasma Prolotherapy

Doctors in Taiwan publishing their study in the medical journal Experimental gerontology examined the effects of Platelet Rich Plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Here is their research summary:

  • Patients with knee osteoarthritis are often complicated with joint soreness, swelling, weakness, and pain. These complaints are often caused by the excessive amount of synovial fluid accumulated in the bursae around the knee joint.
  • They examined the effectiveness of platelet rich plasma in treating patients with minor to moderate knee osteoarthritis combined with supra-patellar bursitis.
  • Twenty-four elderly patients with minor to moderate knee osteoarthritis combined with supra-patellar bursitis were recruited.
  • Aspiration of the synovial fluid was performed under ultrasound followed by subsequent PRP injections.
  • Three monthly PRP injections were performed to the affected knees for a total of 3 months.
  • Approximately after the 2nd PRP injection, significant decreases in synovial fluid total protein concentrations and volumes (signifying a decrease in inflammation), and Lequesne index values (this is a value given to measure the severity of knee osteoarthritis) were observed.
  • Therefore, at least two monthly PRP injections may be beneficial for treating patients with minor to moderate knee osteoarthritis combined with supra-patellar bursitis.(5)

How to treat knee instability and synovitis – Stem Cell Prolotherapy

The video above will explain the Stem Cell Prolotherapy procedure.

For  more detailed discussion please see our article, Stem Cell Therapy for cartilage regeneration

Stem cells can help change a diseased, inflamed joint environment into a pro-healing healing by changing the body chemicals involved in healing.

Early and advanced knee inflammation and osteoarthritis requires a health professional familiar with using inflammation to heal

Doctors at the University of Toronto tested the effects of stem cell treatment in early and late-stage knee osteoarthritis by measuring the stem cell’s cytokine secretion (small proteins which initiate healing and rebuilding of damaged tissue) after it was exposed to arthritic synovial fluid obtained from early- vs late-stage knee osteoarthritis patients.

Following exposure to the osteoarthritic synovial fluid and a three day culture period, the stem cells secreted proteins involved in tissue repair, angiogenesis (development of new blood vessels), chemotaxis (migration of cells to the injured tissue), matrix remodeling (wound healing) and the clotting process.

However, chemokine (white blood cell response to injury or infection) ligand-8 (influences cell migration to site of infection or injury), interleukin-6 (a pro- and anti-inflammatory)  and chemokine (influences cell migration to site of infection or injury) were elevated in the earlier stages of knee osteoarthritis. Signalling that early vs late stage osteoarthritis patients need to be treated differently when employing stem cells.(6

Which tells us that early and advanced knee inflammation and osteoarthritis requires a health professional and a patient familiar with the ways of inflammation and healing.

Do you have questions about Synovial inflammation of the knee? You can get help and information from our Caring Medical staff

References
1 Havelin J, Imbert I, Cormier J, Allen J, Porreca F, King T. Central Sensitization and Neuropathic Features of Ongoing Pain in a Rat Model of Advanced Osteoarthritis. J Pain. 2016 Mar;17(3):374-82. [Google Scholar]

2 McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis Google ScholarJAMA. 2017;317(19):1967-1975.[Google Scholar]

3 Mirkin G. Why Ice Delays Recovery. March 16, 2014.

4 Egloff C, Hart DA, Hewitt C, Vavken P, Valderrabano V, Herzog W.Joint instability leads to long-term alterations to knee synovium and osteoarthritis in a rabbit model. Osteoarthritis Cartilage. 2016 Jun;24(6):1054-60.[Google Scholar]

5 Chen CPC, Cheng CH, Hsu CC, Lin HC, Tsai YR, Chen JL. The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol. 2017 Apr 20;93:68-72.[Google Scholar]

6 Gómez-Aristizábal A, Sharma A, Bakooshli MA, Kapoor M, Gilbert PM, Viswanathan S, Gandhi R. Stage-specific differences in secretory profile of mesenchymal stromal cells (MSCs) subjected to early- vs late-stage OA synovial fluid. Osteoarthritis Cartilage. 2017 May;25(5):737-741.[Google Scholar]

 

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