We discuss how critical interactions between tissue resident cell types regulate the disease state by establishing critical cellular checkpoints within the synovium designed to suppress inflammation and restore joint homeostasis. ![]() In this review, we will discuss the phenotypic and functional heterogeneity of tissue resident synovial cells and how this cellular diversity contributes to joint inflammation. Recent insights into the heterogeneity of tissue resident synovial cells, including macropahges and fibroblasts has revealed distinct subsets of these cells that differentially regulate specific aspects of inflammatory joint pathology, paving the way for targeted interventions to specifically modulate the behaviour of these cells. A major barrier for the identification of therapeutic targets and successful clinical translation is the limited understanding of the cellular mechanisms that operate within the synovial microenvironment to sustain joint inflammation. These observations suggest the existence of additional pathways of disease persistence that remain to be identified and targeted therapeutically. In addition, many patients who acheive clinical remission, quickly relapse following the withdrawal of treatment. Whilst the introduction of targeted biological drugs has led to a step change in the management of RA, 30-40% of patients do not respond adequately to these treatments, regardless of the mechanism of action of the drug used (ceiling of therapeutic response). The medical surgeons in the MASH Study Group are defining the extent of synovitis and seeing how outcomes are related to it, while controlling for other joint injuries.Rheumatoid arthritis (RA) is a chronic prototypic immune-mediated inflammatory disease which is characterized by persistent synovial inflammation, leading to progressive joint destruction. The Multicenter Arthroscopy Study of the Hip (MASH) is looking at the role of synovitis in the outcomes of patients undergoing hip arthroscopy. However, there are rare circumstances in which patients get relief for a very short time, or potentially months or years. When injections do help in relieving pain, the length of relief averages several weeks. The effect of these steroid injections is limited over the long term in most cases. Injections of the joint, and especially with steroids, are known to decrease inflammation and synovitis in joints. Systemic diseases such as these are best treated with medications that treat all joints, but orthopedic intervention may be necessary when specific joints are involved and have caused inflammation and damage. ![]() Diseases of the synovium, such as a number of rheumatologic diseases including rheumatoid arthritis and Systemic Lupus Erythematosus, cause injury to the joint are immune mediated. In some cases, the synovitis itself may be the cause of joint damage and be the main cause of joint pain and dysfunction. At the time of surgery, the synovitis may be removed, typically as part of other forms of treatment to the joint, such as labrum repairs, ligamentum teres debridements, and articular cartilage treatments, such cartilage shaving, smoothing, or microfracture. Synovitis is typically associated with other forms of structural damage in the hip joint, such as labrum tears, articular cartilage damage, and ligamentum teres tears. Synovitis may cause pain regardless of activity levels, including at nighttime. You can also book an office appointment or a telemedicine visit by calling Dr.
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