One of the main reasons for joint pain and effusion is an inflammation of the synovial membrane either caused by an autoimmune response in case of rheumatoid arthritis, chronic reactive arthritis, and arthritis in other immunoarthritic "rheumatoid" disorders or caused by mechanical stress and abrasion of cartilage and/or bone in case of osteoarthritis. Treatment of inflammatory joints therefore depends on the type of the underlying disease and is based on systemic drug therapy and local joint treatment. In rheumatoid arthritis, systemic baseline treatment with anti-inflammatory and immunosuppresive drugs is considered mandatory as rheumatoid arthritis is not only a disease of the joints but also of adjacent tendon sheaths and bursae. Generalized forms of rheumatoid arthritis with vasculitis and visceral involvement are common. Pain and joint swelling are often satisfactorily treated by systemic baseline therapy but often single joints remain painful and require additional local treatment in order to avoid severe side effects which may be caused by an intensified drug regimen. Local therapy is also frequently indicated in all cases of mono- or oligoarthritis such as osteoar-thritis, pigmented villonodular synovitis, chronic postarthroplasty-synovitis, or chronic reactive arthritis. Well-established local treatment options are surgical resection, intra-articular steroid application, and radiosynoviorthesis. Surgical procedures, ranging from open-joint surgery to minimally invasive arthroscopic synovectomy, are associated with risks of surgery and anesthesia, need for hos-pitalization, and a prolonged period of rehabilitation. Long-term success rates for surgery are about 50% to 80% with a high risk of relapse, especially in case of pigmented villonodular synovitis. Chemical synovectomy by intra-articu-lar application of anti-inflammatory and antiproliferative substances like osmic acid, nitrogen mustards, methotrexate, and cobra venom has been almost completely abandoned because of possible joint damage caused by these highly toxic compounds. Intra-articular injection of corticosteroids was first described in 1951 (3) and is still the most frequently applied and widespread therapeutic approach in the local treatment of synovitis. However, many studies have described negative effects on articular cartilage metabolism and vitality (4-7). Furthermore, repeated intra-articular steroid applications often result in increasingly shorter time periods of effective pain relief. Therefore, only few repeated injections per joint are recommended. Owing to the limitations of local treatment modalities, radiosynoviorthesis has become an alternative and in part supplementary therapeutic approach for the treatment of painful inflammatory joint disease, chronic recurrent joint effusion, or osteoarthritis.
Was this article helpful?
Did You Know That Herbs and Spices Have Been Used to Treat Rheumatoid Arthritis Successfully for Thousands of Years Do you suffer with rheumatoid arthritis Would you like to know which herbs and spices naturally reduce inflammation and pain 'Treating Rheumatoid Arthritis with Herbs, Spices and Roots' is a short report which shows you where to start.