From the Guidelines
Synovitis of the knee is best treated with oral NSAIDs, as they are recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated, according to the most recent and highest quality study 1.
Treatment Approach
The treatment approach for synovitis of the knee should prioritize reducing inflammation and pain.
- Start with NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain, as recommended by the American Academy of Orthopaedic Surgeons 1.
- Apply ice to the affected knee for 15-20 minutes every 2-3 hours during the first 48-72 hours to decrease swelling.
- Rest the knee and avoid activities that worsen symptoms, but complete immobilization is not recommended.
Additional Considerations
Once acute pain improves, begin gentle range-of-motion exercises and gradually progress to strengthening exercises under the guidance of a physical therapist.
- For moderate to severe cases, a corticosteroid injection (such as methylprednisolone 40-80mg or triamcinolone 20-40mg) directly into the joint may be recommended for faster relief, as supported by evidence from the EULAR recommendations 1.
- In cases where synovitis is caused by an underlying condition like rheumatoid arthritis, treating the primary condition is essential.
- If conservative measures fail after 4-6 weeks, further evaluation may be needed to rule out other conditions or consider more aggressive interventions.
Rationale
Synovitis responds well to these treatments because they target the inflammatory process in the synovial membrane that causes pain and swelling.
- The use of oral NSAIDs is supported by strong evidence, with a strength of recommendation of "Strong" according to the AAOS clinical practice guideline summary 1.
- While other treatments, such as paracetamol and topical NSAIDs, may be considered, the most recent and highest quality study recommends oral NSAIDs as the first-line treatment for knee osteoarthritis 1.
From the Research
Synovitis Knee Treatment Options
- Transient synovitis can be treated with painkillers, NSAIDs, and/or corticosteroids, depending on severity 2
- Persistent synovitis may also require disease-modifying drugs, and clinical indicators of persistence include symptom duration, early morning stiffness, and rheumatoid factor positivity 2
- Arthroscopic synovectomy and open synovectomy are two surgical options for treating chronic synovitis of the knee, with arthroscopic synovectomy being the preferred option due to faster recovery, less postoperative pain, and excellent cosmetic effect 3
Surgical Treatment for Synovitis
- Synovectomy is the routine surgical treatment for cases of therapy-resistant exudative synovitis or teno-synovitis, and early synovectomy can achieve complete local relief of pain in nearly all cases 4
- Arthroscopic synovectomy offers advantages over open synovectomy, including a more thorough evaluation of the joint and synovium, better access for surgical synovectomy, and decreased postoperative morbidity 5