From the Guidelines
Synovitis in the hand should be managed with a combination of non-pharmacological and pharmacological treatments, prioritizing clinical examination as the method of choice for detecting synovitis, as recommended by the 2016 EULAR update 1. The management of synovitis in the hand involves a comprehensive approach, including:
- Clinical examination to detect synovitis, which may be confirmed by ultrasonography (US) or other imaging modalities if necessary 1
- Non-pharmacological interventions such as education, exercise, and physical therapy to maintain joint mobility and strength
- Pharmacological treatments, including:
- Topical NSAIDs and capsaicin for mild to moderate pain 1
- Oral NSAIDs, such as ibuprofen or naproxen, at the lowest effective dose and for the shortest duration, with consideration of gastrointestinal and cardiovascular risks 1
- Disease-modifying antirheumatic drugs (DMARDs) if the synovitis is related to an underlying inflammatory condition like rheumatoid arthritis 1
- Intra-articular injections of corticosteroids for painful flares of OA, especially trapeziometacarpal joint OA 1 It is essential to individualize treatment according to the patient's requirements, taking into account the localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life, as well as comorbidity and co-medication 1. Regular monitoring of disease activity, including tender and swollen joint count, patient's and physician's global assessments, ESR, and CRP, is crucial to guide decisions on treatment strategies 1. Ultimately, the goal of treatment is to achieve remission, prevent joint damage, and improve quality of life, with a focus on minimizing morbidity, mortality, and optimizing outcomes.
From the Research
Synovitis in Hand
- Synovitis is a painful and occasionally disabling disease that can affect the hands, among other joints 2.
- The management of synovitis in the hand can be challenging and may require a combination of conservative treatments, including physical modalities such as ultrasound therapy, low-level laser therapy, and phonophoresis 3.
- In some cases, synovitis in the hand may be associated with underlying conditions such as rheumatoid arthritis, which can require disease-modifying drugs and other treatments 2, 4.
- Arthroscopic synovectomy may be a useful tool for managing synovial disorders in the hand, although this is more commonly used for conditions such as pigmented villonodular synovitis and synovial chondromatosis 5.
- Radiosynovectomy using (177)Lu-labeled hydroxyapatite particulates has been shown to be effective in treating painful synovitis of the knee joint due to rheumatoid arthritis, although its use in the hand has not been specifically studied 6.
- Intra-articular therapy with methotrexate or tumor necrosis factor inhibitors may be considered for persistent monoarthritis in rheumatoid arthritis, although the optimal dose and frequency of injections are yet unknown 4.
Treatment Options
- Conservative treatments such as painkillers, NSAIDs, and corticosteroids may be used to manage transient synovitis in the hand 2.
- Disease-modifying drugs may be required for persistent synovitis in the hand, especially if associated with underlying conditions such as rheumatoid arthritis 2, 4.
- Physical modalities such as ultrasound therapy and low-level laser therapy may be effective in treating De Quervain tenosynovitis and other conditions affecting the hand 3.
- Arthroscopic synovectomy and radiosynovectomy may be considered for more severe or refractory cases of synovitis in the hand 5, 6.