Pharmacological management of transient synovitis

Synovitis is a painful and, occasionally, disabling disease. Patients with synovitis, especially new onset synovitis, should be referred to a rheumatologist urgently so that they can be assed and treated as quickly as possible. Clinical assessment and investigations are required to help differentiate between transient (< 3 months) and persistent (> 3 months) synovitis. This differentiation is important, as persistent synovitis can lead to joint damage and disability. Septic arthritis is a rheumatological emergency requiring immediate assessment and specific treatment. The earlier synovitis is treated, the more effective treatment is likely to be. If treated very early, there is potential to prevent the move from transient to persistent synovitis. Transient synovitis can be treated with painkillers, NSAIDs and/or corticosteroids, depending on severity. Persistent synovitis may also require disease-modifying drugs. Clinical indicators of persistence include symptom duration at first visit, early morning stiffness for > 1 h, arthritis in more than three joints, bilateral compression pain in metatarsophalangeal joints, rheumatoid factor positivity, anti-cyclic citrullinated peptide antibody positivity, erosions on hand or feet X-rays and a family history of rheumatoid arthritis. Disease-modifying drugs need to be considered early to achieve clinical remission before damage and disability occur. Despite emerging new treatments for synovitis, especially persistent synovitis, full clinical remission is still not achieved in most patients, and more research into disease processes and targeted therapies is required.