From the Guidelines
Transient synovitis in pediatric patients is a self-limiting condition that can be effectively managed with rest, anti-inflammatory medications, and close monitoring, with most cases resolving within 1-2 weeks without long-term complications. The diagnosis of transient synovitis is often made by excluding more serious conditions such as septic arthritis, which requires immediate medical attention 1. The Kocher criteria, which include fever, erythrocyte sedimentation rate, white blood cell count, and inability to bear weight, can be used to distinguish septic arthritis from transient synovitis, with a higher likelihood of septic arthritis if more criteria are met 1.
Key considerations in the management of transient synovitis include:
- Resting the affected joint to reduce inflammation and pain
- Using anti-inflammatory medications such as ibuprofen (10 mg/kg/dose every 6-8 hours) or naproxen (5-7 mg/kg/dose twice daily) for 3-5 days to reduce inflammation and pain 1
- Maintaining adequate hydration and following up with a healthcare provider if symptoms worsen or do not improve within a week
- Monitoring for warning signs that warrant urgent evaluation, such as fever over 101°F, severe pain, inability to bear weight, or worsening symptoms despite treatment
It is essential to distinguish transient synovitis from more serious conditions like septic arthritis, which requires immediate medical attention 1. Imaging studies, such as ultrasound or fluoroscopy, may be conditionally recommended for use with intraarticular glucocorticoid injections of joints that are difficult to access, or to specifically localize the distribution of inflammation 1. However, radiography is not sensitive enough to assess joint inflammation and enthesitis in children and may delay clinically appropriate imaging and treatment 1.
In terms of specific treatment, the use of anti-inflammatory medications like ibuprofen or naproxen is conditionally recommended as adjunct therapy for symptom management, particularly during initiation or escalation of therapy with disease-modifying antirheumatic drugs (DMARDs) or biologics 1. However, it is crucial to note that NSAIDs are not appropriate as monotherapy for chronic, persistent synovitis 1.
Overall, the management of transient synovitis in pediatric patients should prioritize a conservative approach with rest, anti-inflammatory medications, and close monitoring, while being vigilant for signs of more serious conditions that require immediate medical attention.
From the Research
Diagnosis of Transient Synovitis
- Transient synovitis is the most common cause of acute hip pain in children three to 10 years of age 2
- Children with this condition typically present with hip pain for one to three days, accompanied by limping or the refusal to bear weight 2
- The etiology of the condition is unknown, although in a few cases a recent history of an upper respiratory tract infection may be present 3
- Diagnostic procedures include:
- Differential diagnoses that should be considered include septic arthritis, Perthes disease, and osteomyelitis 3, 2
Treatment of Transient Synovitis
- Treatment consists of bed rest and nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 2, 4
- NSAIDs have been shown to shorten the duration of symptoms in children with transient synovitis of the hip 4
- Ibuprofen is a commonly used NSAID in children, with a good tolerance profile and effective in reducing fever, alleviating pain, and reducing inflammation 4, 5
- Regular temperature checks should be performed to exclude the onset of fever 2
- Follow-up care should occur 2 weeks after diagnosis to ensure there is no recurrence of the joint effusion or progression to avascular necrosis, with radiographs of the hip repeated at 1 month and 3 months 3