Synovitis in osteoarthritis: the current state of the problem

The article presents current data on synovitis (inflammation of the synovial membrane), which is often the only clinical manifestation of osteoarthritis (OA), and considered to be one of the risk factors for the OA development. Synovitis severity correlates with the severity of OA symptoms. The assessment of the prevalence of synovitis presents significant difficulties and depends on the nature and severity of the disease, the cohort in question, diagnostic method, and therapy. The classification based on etiological, clinical and histological characteristics of synovitis is presented. Examination of synovial tissue characteristics and its changes during inflammatory response can significantly expand the possibilities for therapy and prognosis. The use of symptomatic delayed-action drugs (SYSADOA) is considered as the basic treatment of OA. Chondroitin sulfate (Chondroquard®) is one of the well established drugs, it has symptom- and structural-modifying properties. The article presents the results of studies confirming its effectiveness in reducing the severity of knee synovitis.

1. Smith MD. The normal synovium. Open Rheumatol J. 2011;5:100-6. doi: 10.2174/1874312901105010100. Epub 2011 Dec 30.

2. Tarner IH, Hä rle P, Mü ller-Ladner U, et al. The different stages of synovitis: acute vs chronic, early vs late and non-erosive vs erosive. Best Pract Res Clin Rheumatol. 2005; 19(1):19-35. doi:10.1016/j.berh.2004.08.002

3. Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis. Bone. 2012;51(2):249-57. doi:10.1016/j.bone.2012.02.012

4. Guillen Astete C, Lois Iglesias A, Blazquez Canamero M, et al. Asymptomatic lupus arthropathy: comparison of ultrasonographic findings with healthy people. Annals of the Rheumatic Diseases. 2012;71(suppl 3):605.

5. Brown AK, Quinn MA, Karim Z, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum. 2006 Dec;54(12):3761-73. doi: 10.1002/art.22190.

6. Zufferey P, Mö ller B, Brulhart L, et al. Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: results of an observational cohort study. Joint Bone Spine. 2014 Oct;81(5):426- 32. doi: 10.1016/j.jbspin.2014.04.014. Epub 2014 Jun 20.

7. Alekseeva OG. Joint ultrasonography in rheumatoid arthritis: pathogenetic rationale, possible use in diagnosis, therapy efficiency evaluation, and outcome prediction. Nauchno-Prakticheskaya Revmatologiya. 2018;56(1):82-92. (In Russ.).

8. Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther. 2017 Feb 2;19(1):18. doi: 10.1186/s13075-017-1229-9.

9. Felson DT, Niu J, Neogi T, et al. Synovitis and the risk of knee osteoarthritis: the MOST Study. Osteoarthritis Cartilage. 2016;24(3):458-64. doi:10.1016/j.joca.2015.09.013

10. Goldring MB. Cartilage Biology: Overview. In: Zaidi M, editor. Encyclopedia of Bone Biology. Academic Press; 2020. P. 521-34.

11. Guermazi A, Roemer FW, Hayashi D, et al. Assessment of synovitis with contrastenhanced MRI using a whole-joint semiquantitative scoring system in people with, or at high risk of, knee osteoarthritis: the MOST study. Ann Rheum Dis. 2011;70(5):805-11. doi:10.1136/ard.2010.139618

12. Kashevarova NG, Taskina EA, Alekseeva LI. Synovitis of the knee joints – a factor in the progression of osteoarthritis. IV International Congress of the Association of Rheumoortopeds. Abstracts of the Congress reports. 2020. P. 37-8.

13. Roman-Blas JA, Herrero-Beaumont G. Osteoarthritis pathophysiology: similarities and dissimilarities with other rheumatological diseases and the role of subchondral bone. Medicographia. 2013;35:158-63

14. D'Agostino MA, Conaghan P, Le Bars M, et al. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: Prevalence of inflammation in osteoarthritis. Ann Rheum Dis. 2005 Dec;64(12): 1703-9. doi: 10.1136/ard.2005.037994. Epub 2005 May 5.

15. Sarmanova A, Hall M, Moses J, et al. Synovial changes detected by ultrasound in people with knee osteoarthritis – a metaanalysis of observational studies. Osteoarthritis Cartilage. 2016 Aug;24(8):1376-83. doi: 10.1016/j.joca.2016.03.004. Epub 2016 Mar 10.

16. Wenham CY, Conaghan PG. The role of synovitis in osteoarthritis. Ther Adv Musculoskelet Dis. 2010;2(6):349-59. doi:10.1177/1759720X10378373

17. Oehler S, Neureiter D, Meyer-Scholten C, Aigner T. Subtyping of osteoarthritic synoviopathy. Clin Exp Rheumatol. 2002;20(5):633-40.

18. Henrotin Y, Pesesse L, Lambert C. Targeting the synovial angiogenesis as a novel treatment approach to osteoarthritis. Ther Adv Musculoskelet Dis. 2014;6(1):20-34. doi:10.1177/1759720X13514669

19. Hirata A, Ogura T, Hayashi N, et al. Concordance of Patient-Reported Joint Symptoms, Physician-Examined Arthritic Signs, and Ultrasound-Detected Synovitis in Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2017;69(6):801-6. doi:10.1002/acr.23006

20. D'Agostino M, Terslev L, Aegerter P, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open 2017;3:e000428. doi: 10.1136/rmdopen-2016-000428

21. Berruto M, Murgo A, Ferrua P, et al. Synovitis of the Knee. In: Randelli P, Dejour D, van Dijk N, et al editors. Arthroscopy. Springer; 2016. P. 373-86.

22. Peacock DJ, Banquerigo ML, Brahn E. Angiogenesis inhibition suppresses collagen arthritis. J Exp Med. 1992 Apr 1;175(4): 1135-8. doi: 10.1084/jem.175.4.1135.

23. Oliver SJ, Banquerigo ML, Brahn E. Suppression of collagen-induced arthritis using an angiogenesis inhibitor, AGM-1470, and a microtubule stabilizer, taxol. Cell Immunol. 1994;157(1):291-9. doi:10.1006/cimm.1994.1223

24. Fritz P, Laschner W, Saal JG, et al. Histological classification of synovitis. Zentralblatt fur Allgemeine Pathologie und Pathologische Anatomie. 1989;135(8):729-41.

25. Krenn V, Morawietz L, Hä upl T, et al. Grading of Chronic Synovitis – A Histopathological Grading System for Molecular and Diagnostic Pathology. Pathol Res Pract. 2002;198(5):317-25. doi: 10.1078/0344-0338-5710261.

26. Krenn V, Perino G, Ruther S, et al. 15-year experience in the application of the histopathological scale and the diagnostic algorithm of synovitis: assessment and further development. Travmatologiya i ortopediya Rossii. 2017;(2):39-48. (In Russ.).

27. Najm A, le Goff B, Venet G, et al. IMSYC immunologic synovitis score: A new score for synovial membrane characterization in inflammatory and non-inflammatory arthritis. Joint Bone Spine. 2019;86(1):77-81. doi:10.1016/j.jbspin.2018.04.004

28. Olyunin YuA. Chronic synovitis in rheumatology. Evaluation of activity and treatment tactics. Russkii meditsinskii zhurnal. 2005;13(8):548-55. (In Russ.).

29. Balabanova RM, Olyunin YuA, Lila AM. Radiosynovectomy-an alternative to surgical synovectomy in rheumatological patients with recurrent arthritis. Russkii meditsinskii zhurnal. 2019;3(4(I)):17-9. (In Russ.).

30. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthritis Cartilage. 1998 May;6 Suppl A:14-21.

31. Calamia V, Mateos J, Fernandez-Puente P, et al. A pharmacoproteomic study confirms the synergistic effect of chondroitin sulfate and glucosamine. Sci Rep. 2014 Jun 10; 4:5069. doi: 10.1038/srep05069

32. Lambert C, Mathy-Hartert M, Dubuc JE, et al. Characterization of synovial angiogene sis in osteoarthritis patients and its modulation by chondroitin sulfate. Arthritis Res Ther. 2012 Mar 12;14(2):R58. doi: 10.1186/ar3771.

33. Tat SK, Pelletier JP, Verges J, et al. Chondroitin and glucosamine sulfate in combination decrease the pro-resorptive properties of human osteoarthritis subchondral bone osteoblasts: a basic science study. Arthritis Res Ther. 2007;9(6):R117.

34. Sarvilina IV, Galustyan AN, Khadzhidis AK, et al. Comparative clinical and economic analysis of the use of SYSADOA preparations containing chondroitin sulfate or affecting its biosynthesis for the treatment of patients with stage II knee osteoarthritis. Sovremennaya Farmakoekonomika i Farmakoepidemiologiya. 2019;12(4):1-12. (In Russ.).

35. Alekseeva LI, Anikin SG, Sharapova EP, et al. Study of the efficacy, tolerance and safety of Chondrogard in patients with osteoarthritis. Russkii meditsinskii zhurnal. 2013;(32): 1624-7. (In Russ.).

36. Alekseeva LI, Anikin SG, Zaitseva EM, et al. Study of the efficacy, tolerability and safety of Chondrogard in patients with osteoarthritis. Farmateka. 2013;(7):58-62. (In Russ.).

37. Alekseeva LI, Sharapova EP, Kashevarova NG, et al. Comparative study of the efficacy and safety of the drug Chondroquard® in combined (intra-articular and intramuscular) and intramuscular administration in patients with osteoarthritis of the knee joints. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2018;12(2):44-9. (In Russ.). doi: 10.14412/1996-7012-2018-2-44-49

38. Radenska-Lopovok SG. Immunomorphological characteristics of the synovial membrane in rheumatic diseases. Arkhiv patologii. 2016;78(4):64-8. (In Russ.).