Can anyone enlighten me as to the difference between synovial thickening and synovitis? Also, the difference between synovial thickening and enhancement.
Both synovial thickening and synovial enhancement have shown up on scans but I am informed this is nothing to do with synovitis!
I'm going to be spectacularly unhelpful and say "I don't know". Rheum told me I had synovial thickening which wasn't active inflammation but damage. However, rheum nurse told me it was just another word for inflammation AKA it was synovitis. Going on my RA history and my googling (!), I think it is damage to the joint lining.
Thanks. Yes, I think it is. Story is that I woke up one morning in July 2014 with stabbing pain in thumb and my index and middle finger jammed stiff, pain in forearms, burning and stiffness, whole hand stiff and could not write my name, turn a key, put ear-rings in, fill the kettle, dropping and smashing things. Pain in feet, swollen toe with rash, pain in knees, shoulders, elbows, nodules in wrists and on some fingers developed over the next few weeks, with a new development each day.
Six months for a referral and an ultrasound showed synovial thickening in all knuckles and increased vascularity, joint effusions in hands and wrists, very bad inflammation in right shoulder. Also, sonographer said hand tendons badly flamed and swollen. Rheumatologist said this was nothing and there was no synovitis.
Six months after that, he decided to do an MRI scan to check he had not missed anything, though I was greatly improved by then with electro acupuncture, Chinese herbal tablets and patches as well as the gym.
MRI of hand showed the same as the ultrasound but, if anything, a slight improvement. This time it was called synovial enhancement with increased vascularity, all in the same areas. This time he said it was inflammation and rheumatoid arthritis.
My guess is that I had been dismissed out of hand initially and they were so gobsmacked when they got the ultrasound report they did not know what to say. Either that or they were trying to force me to go private.
So much for getting treatment in the first three months as per the NHS website. So much also for telling them about my various rashes and allergies, which result in psoriasis if I do not take anti histamines. Of course, I was told psoriasis was "just nothing" as well.
Whilst waiting for an NHS appt, I saw a private rheumatologist who told me it was bad posture, then gout, then referred me to his physio. I went to my own physio and she said I was the most unlikely gout patient she had ever had and she was sure it was rheumatoid arthritis and to get a second opinion.
Hi apologies for asking but I wondered if you could give me some advice with a similar condition to yours, late last year I had an impact injury on my index finger that went away on it's own within a few weeks. In January I noticed the knuckle was swelling and limited in movement. After several xrays/ultrasound the prognosis is a thickening of the synovial coating, with no obvious arthritis, gout etc. I do suffer from Psoriasis and have made the specialists aware. My question basically is as you have similar symptoms to me has you condition improved and hopefully if it has what treatment did you have as my choices are 1 do nothing , 2 a steroid jab, 3 refer to surgeon...which I have gone for. Any advice would be appreciated thanks
Sorry for the enormous delay but I have only just picked this up - quite how at this moment, I don't know.
I did get various improvements. The two areas greatly affected were my shoulders and hands/wrists up to the elbows, though I had pain and swelling and other symptoms elsewhere.
The initial greatest improvement for the hands was electro acupuncture. It unjammed my fingers on the first session after 35 minutes and I then had a course of about 20 sessions. I also found Chinese herbal tablets a big help. I did not take them for a while after starting the electro acupuncture because I wanted to see what was working. I can't get them at the moment because under EU rules, importers have to have a licence costing £30,000 for each tablet type. The tablets I took comprised Dong Quai, Danshen, Frankincense, Myrrh and Liquorice. They have a remarkable cognitive effect on me - maybe because they are oestrogenic.
I had a steroid injection in my shoulder which helped 90% for ten weeks. I then tried hydroxychloroquine but its effect was limited on its own. In conjunction with the Chinese tablets, I obtained a 100% resolution in 2016 and it has not recurred.
In August 2016, when I had run out of Chinese tablets, I had an awful flare up in my hands and luckily found another bottle. They took down the huge hand swelling within a day or two. The type of pain is not continuous as most people on here describe, but it comes as a sudden crack of pain or extremely piercing pain, and it has often made me scream but it only lasts a matter of seconds for each wave of pain on/off over a few minutes. It is particularly bad in the middle finger joints with nodules appearing, across the knuckles and in the thumb base and sometimes in the wrists. However, the pain does not really bother me - what bothered me hugely was the loss of function and in fact total disability.
I've been quite good over the last couple of years and was discharged from hospital in August 2017 as I felt I did not need medication. My hands never completely resolved but were about 90% improved. However, over the last few weeks I have had awful flaring in the hands and sudden pain that has taken my breath away. My hands have from time to time just locked across the knuckes and front/back of the palm area. Thinking over the summer, I did get badly bitten by insects yet again this summer. I strongly suspected the initial attack was the result of being very badly bitten in 2013 (30 bites on each leg, mainly the knees). Another factor is that I notice that the gym and swimming and daily heavy exercise does help my hands. I have not been doing the gym and swimming so much lately as I have chest and breathing problems. People don't understand how the gym can help flexibility and relieve pain in the hands but it definitely does. I also notice that alcohol is bad for the hands (especially beer and white wine though red wine is OK). Alcohol is not the current cause though because i have not had any. Also, since Easter I have had the same stabbing pain in my knees. I had this in 2014 when the condition started but nothing was found on ultrasound. At Easter also, I had the most terrible lower back pain (Good Friday through to Easter Monday) which went around to my stomach. I went to the gym every other day and with each visit there was an improvement until the back pain went completely. I don't know what that was.
I hope this helps. Don't hesitate to reply if you need further info.
What about psioratic arthritis? Have any of your medical team considered that?
Anyway, my take on it is that synovitis is the active inflammation, often through loads of synovial fluid sloshing around in your joints, that results in synovial thickening.... whether you can get synovial thickening from processes other than synovitis I don't know. And enhancement is a word I've heard associated with MRI's in terms of the type of MRI it is, ie MRI with contrast, with enhancement, etc etc, but not as a type of damage.
Perhaps they were trying to convince you that changes to your joints were a good thing, not a result of their uselessness. As in "your membership package has been enhanced" which usually means I'm being asked to pay more for the same service.
Which hospital? One in london, starting with G? You are right. Funding issue.
Thanks for asking this question. Ive also been told I have synovial
Thickening but no progressive disease. Feel like saying 'what on earth do you call what is happening to me then!' it is really sad that we are put off with unclear vague non dx but a GP also said Rhuematologists often dont know what is going on by nature of the complexity of these illnesses so trying to be patient with all the non answers I have had (in 2 and half years of pain and stiffness). I know many have had long journeyd to getting dx. Hope you have answers soon and can get good treatment.
2 years ago.....I can't remember what I thought yesterday! I imagine I suggested that more because RA tends to show active inflammation and synovitis, so if you don't have that but lots of the other symptoms then more likely to be one of the other inflammatory arthrites?
I'm not sure it is. The general consensus of opinion is that the synovial thickening is joint damage, and that it appears when onset is sudden and severe or very longstanding. I think it depends on which joints are affected. In RA, it is usually the hands but can be the hands in psoriatic arthritis. However, RA tends to affect the knuckles and joints half way up the fingers (plus the wrists and thumb base) whereas psoriatic arthritis tends to affect the joints at the tip of fingers and the nails. Mine is in the knuckles and mid finger joints, thumb base, wrists.
RA tends to come and go so it is feasible, I suppose, that when you have the imaging done that it is not active.
It is a puzzle because I do have a severe scaling rash on my feet and the condition started with a rash round the big toe, but moved all around the foot at different times. The big toe nail has now turned black and the scaly rash has spread to my lower legs and is a bit itchy.. The rheumy said the areas affected are typically RA - but not every case can be a hard and fast one. He has left me to get a diagnosis of psoriasis or get it ruled out. I am inclined to think it is psoriasis but don't know if this automatically makes it psoriatic arthritis. I do have some symptoms of it - in the sacro iliac region and in the neck from time to time.
That's good....thanks. Another piece of my understanding jigsaw.
Thanks, that is very helpful. I did have effusions as well. Initially, the consultant rheumy told me that synovial thickening is not the same as synovitis but I did not believe him. I am afraid they flit arsed around so much (six months!) that they were gobsmacked when they got the ultrasound report. I also had swollen finger tendons and a large nodule on the middle joint of the first righthand finger. I waited so long for an initial NHS appt that I saw a private rheumy who told me that nodule was a typical gout topi - without ever doing any imaging tests. He thought that because I had uric acid blood levels off the radar but (at the time) normal blood tests for RA. This sort of guess work is not to me medically acceptable or reasonably competent.
Quite frankly, I find them all a bunch of jokers. If I were in my 30s, I would be suing them. When I got this sudden onset, I was 65, so at the end of my working life. I still work on and off. Whist my shoulder has resolved, and my fingers are near normal, I still get flare ups in my fingers which inhibit my work (can't write properly) and I suspect if I were young would render me eventually unable to work in years to come.
I found ultrasound excellent. It only took 20 minutes and the sonographer explains to you what is on the screen. The machine flashes up red asterisks at areas of inflammation. The synovial thickening was very clear. Of particular note is that the knuckle of the ring finger of my right hand was the worst affected yet it was the least swollen/inflamed. I had other nodules - variously a hard bony one on an end finger joint, fleshy lumps including on the wrists, and bits of tendon. I fully expected the private rheumy to do an ultrasound on the first appt. An ultrasound only costs about £100 and is cheaper than MRI. The MRI was a complete torture. I had to lay flat on my face with my right hand raised - with a frozen shoulder - for a solid hour. I would not recommend anybody to have one on their hands if they have RA in the shoulders.
A consultant radiologist did an ultrasound on my shoulder and found large areas of tendon inflammation and bursitis - yet at the time the blood tests were normal. I'm afraid some of these tests and doctors have more in common with Mickey Mouse than effective medicine.
My hands were hugely swollen yet two consultant rheumatologists thought they looked normal. I used to have long, slender fingers which were always very nimble.
I virtually found the cure on my own through Chinese medicine and electro acupuncture. All conventional medicine has done for me is give me a pain in the neck.
I asked my specialist this very question a few weeks ago now and I am waiting for a response to explain the difference. My hands and feet were showing synovial hypertrophy (no synovitis) on ultrasound and I’ve had pain in both. So I’m totally confused 🤷♀️
I’d be interested to know more about your Chinese herbal tablets, as initially I enquired with a local Chinese herbalist, but didn’t hear back. Have they worked for you and can you take them alongside supplements etc?
I've dug out the ultrasound report on my hand (done by a sonographer) and of the MRI scan.
Synovial thickening on the MCP joints (knuckles), esp 4th/5th of right hand and 2nd/3rd/4th of the left. (The joke about that is when I woke up on 8 July 2014, I had piercing pain in the middle joint of the right thumb and my first and middle finger of the right hand were completely jammed, and the 4th/5th just stiff. The left hand went two weeks after the first, which is when I knew this was RA rather than an allergic reaction to an insect bite.)
There is also an increase in vascularity, particularly in the 4th MCP joint of right hand. (the ring finger of the right hand and the only finger hardly swollen - the rest looked enormous. Increased vascularity occurs in RA and means that the thickened synovium has laid down new blood vessels - so definitely RA and quite advanced and complicated)
Joint effusions in the intercarpal joints of the right hand and the carpometacarpal of the left.
Joint effusions at the wrists.
Sonographer told me that the tendon on the first finger of the right hand was horribly swollen and had popped the tendon sheet, which was the nodule at the joint.
X-rays taken at the same time were completely normal and very good - they were fully expecting the condition to be osteoarthritis on account of my age.
A few months after this (March 2015) , I had electro acupuncture and after 35 mins, the first and middle fingers of the right hand started moving. I then had a course of it and started Chinese herbal tablets, which brought about a massive improvement in flexibility in my hands.
In August 2015, I had an MRI scan, just on my right hand. This mirrored the finding of the ultrasound but there was an improvement. It also said there are no significant PIP joint effusions or synovial enhancement of the PIP joints. The joke again is that the rheumy diagnosed RA on the basis of the MRI yet the ultrasound had shown a worse degree of the condition. I just think they did not want to admit that I had RA after the way they had messed me around. The PIP joints are affected in psoriatic arthritis. I think your case is probably similar to mine and on the NHS they just discharge people where they think the disease might be inactive - this is done on cost grounds, not medical grounds.
The ultrasound report on my right shoulder was done by a consultant radiologist who said there was inflammation on the suprasinatus tendon.
There is much talk about RA affecting the joints but it affects the tendons very badly as well. It also goes on to affect various organs. I have developed a very dry mouth and now dry eyes. It eventually affects the vascular system and the heart.
I hope this helps - must get to bed as have to get up for work at my great age! In summary, synovial thickening and increased vascularity in thickened synovium only occurs in inflammatory arthritis.
Gels or creams that actually work for Synovitis is hand??
miffed!!
Remission 
Steroid injection... Ive received my outcome letter but dont understand what all the big words mean
