Villonodular synovitis
introduction
Villonodular synovitis is one benign, proliferative (so growing) Disease of the so-called synovia, so the Synovial fluid and synovium. This synovial fluid fills the joint space, for example the Knee joint and acts there as a lubricant and to supply the im joint lying cartilage structures.
Villonodular synovitis can occur in different shapes occur. On the one hand in a rather limited, nodular form called nodular synovitis. This only affects a narrowly defined area and is mostly good to treat.
On the other hand in a rather diffuse shape villonodular synovitis, the villous type. Usually that is entire joint affected. It tends to spread more widely and often occurs again after surgery. Is also another one pigmentation present in the joint area, one speaks of the pigmented villonodular synovitis (PVNS).
causes
The causes of villonodular synovitis are still completely unclear. The development may be related to the frequent occurrence of bloody joint effusions and previous joint inflammation. The large joints are usually affected, especially the knees and hip joints, but sometimes the shoulder joint as well.
Overall, it is still unclear whether the development is more of a tumor-like course or corresponds to other chronic inflammatory diseases such as arthritis.
Villonodular synovitis is one of the most common synovial diseases. It mostly affects people between 30 and 40 years of age. Villonodular synovitis is a tumorous clinical picture, but it is benign.
Also read on this topic: Inflammation of the synovial membrane
Symptoms
The Symptoms vary depending on the underlying disease type. In the chronic, diffuse form it usually occurs over the years Swelling and pain in the affected joint. The swelling can be very severe due to the increased production of synovial fluid. You can do this too Stress pain occur in the joint area and in the area of the adjacent extremity. Because of these symptoms is a Confusion with other diseases, for example the Vessels possible. In addition, the symptoms are similar to chronic inflammatory diseases such as arthritis.
At the nodular type the disease often falls into one above all Restriction of movement of the joint. That is because here the rather nodular and firm neoplasm gets trapped when moving and causes discomfort. However, they often come here too Pain and swelling added. Typical of villonodular synovitis, however, is that in contrast to many degenerative diseases usually only one joint affected is.
With both variants of villonodular synovitis, the symptoms may only be Occur in phases and gain or decrease over time.
diagnosis
The symptoms per se are more likely with villonodular synovitis not groundbreaking. Hence in any case one is Imaging required. Here you can see above all the mass itself, but also the lack of calcifications or indications of other diseases. In addition to the roentgen, also the CT and MRI Examination.
With all procedures, however, the differentiation from other diseases is rather difficult. Often the villonodular synovitis is initially for example for one cyst held and only identified in the operating room. Overall that is MRI nevertheless the Method of choice, because here, for example, the hemosiderin components in PVNS can already be identified in some cases.
In the further course, a Removal of synovial fluid, or the biopsy of the node shown help to make a diagnosis or at least exclude other diseases. Proof for villonodular synovitis is always the first histological analysis of the cells removed during the operation or biopsy.
therapy
The Therapy of choice usually represents a complete removal of the synovial membrane that mostly too arthroscopic (so minimally invasive) can be carried out.
In the nodular shape the disease is usually enough one-time operation to treat the disease. The diffuse shape tends to after the operation recurrences. To prevent this, follow-up treatment with radiotherapy necessary. The irradiation can take place on the one hand from the outside, but on the other hand also by introducing radioactive substances into the joint. With very advanced courses The condition may also require that entire Remove joint and by one prosthesis to replace.
PVNS
Pigmented villonodular synovitis is a form of villonodular synovitis with an additional one deposit of so-called Hemosiderin crystals at the skin of the knee joint, but also takes place in the joint space. Hemosiderin is created wherever in the body Red blood cells must be dismantled, such as with bruises. In this respect, the discoloration of the skin, but also of the tumor, is often noticeable in this disease.
arthritis
The symptoms of villonodular synovitis can be slightly different from those of one Confused Arthritis become. Especially with the diffuse form, the slow course is similar to that of one rheumatoid arthritis. However, with the villonodular synovitis always only one joint infested. Even if the root cause the disease not yet fully clarified is it doesn't seem any context to give with rheumatoid arthritis.
hip joint
The hip joint is second most common affected by villonodular synovitis. Here too, the complaints are rather unspecific. In addition to the hip joint itself, it often occurs Lumbar pain and back area on.
Knee joint
The knee joint is affected by villonodular synovitis in about 80% of cases and is therefore the joint most affected. Since the disease only affects one joint, the knee pain is not bilateral, as is the case with other diseases. Often the villonodular synovitis cannot be distinguished directly from cysts or other tumors.
Also read the article: Synovitis in the knee.
forecast
The forecast in the nodular shape is already quite good after a single treatment. Often through one-off distance of the tumor the disease cured become.
In the diffuse shape is the quota for one Recurrence the complaints unfortunately higher. However, a Irradiation increase the chances of a long-term cure. In order to restore the function of the joint in the long term, above all one is sufficient in the further course physical therapy to strengthen the Musculature necessary.
