A colleague had been having severe pain in the knee joints since a week now. He could not figure out any particular reason for it. Gradually, he developed a swelling at the knee joint which made it difficult for him to walk. When he consulted his physician, he was advised certain diagnostic tests. Later, he was diagnosed as Pigmented Villonodular synovitis- a name that sounded very unfamiliar and scared him.
Understanding Pigmented Villonodular Synovitis
Pigmented Villonodular synovitis is a condition in which the lining of joint in the hip or knee becomes swollen and overgrows (benign tumor). The overgrown lining around the joint makes more fluid than normal which causes swelling in the area, and there is pain during movement of the joint. This joint problem can also affect joints of elbow, ankle, foot, hand and shoulder.
The synovial tissue forms the lining for the tendons (fiber bands that connect muscle to bone) and also for the bursa which are fluid filled sacs between ligaments, tendons and bones found near the joints. This synovial tissue helps the smooth gliding of joints and tendons. The benign (harmless) tumor that arises from this synovial tissue is called as Pigmented Villonodular synovitis. This does not spread to other parts of the body though it is painful.
Symptoms
Pigmented Villonodular Synovitis may cause swelling in the joints which become painful making it difficult to use one’s limbs. Bloody fluid may accumulate in the joints. There may be a ‘popping’ feeling on moving the joint. The symptoms appear and disappear gradually with time. After the knee, the second most common area where Pigmented Villonodular synovitis occurs is the hip joint where the patients report having intermittent episodes of severe pain. Certain times the patients cannot feel any pain at all and they can get on with normal activities and they may even take part in sports. The episodes of extreme pain in the hip joint are attributed to hemorrhage in the joint.
Causes
There is no particular cause known for Pigmented Villonodular synovitis. It is not seen to run in the families nor is it caused due to any particular activity. It is seen to occur more in men for reasons unknown. It is generally seen to occur between the age groups 20 years to 45 years of age, but can also occur in children.
Diagnosis
The doctor takes X rays in which invisible beams of electromagnetic energy are used to produce images of bones, organs, and internal tissue which are put on a film and studied. In another diagnostic procedure known as MRI (magnetic resonance imaging), radio frequencies and magnetic fields are used to generate detailed images of internal organs on to the computer. Another special X ray technique called as Arthography is done in which a radio opaque substance is injected into the affected area and then the doctor studies the affected joint.
When the tissue is seen through the microscope (histopathological study), Pigmented Villonodular synovitis is characterized by hyperplasia (increase in growth) of synovial cells which are present below or on the surface of the synovium. The other cells that are seen are giant cells, foam cells and hemosiderin (a protein that stores iron in the body).
Treatment
The treatment of Pigmented Villonodular synovitis depends on the overall health and medical history of the patient. The choice of treatment is synovectomy in which the affected lesions are curettaged and grafting of bone is done, if necessary. The treatment involves removing the lining of the joint surgically or with arthroscopy. In arthroscopy, the doctor makes a small cut on the skin over the joint and then passes a tube into the joint with the help of which the lining is removed. Even after treatment Pigmented Villonodular synovitis may return and cause pain. In such cases, radiation therapy is done. In severe cases, the joint is completely replaced which is known as arthrodesis.
Coping and support
People who have undergone surgery as a part of treatment need to take anti inflammatory medications (ibuprofen, naproxen and aspirin) and rest as suggested by the doctor. Crutches may be advised to keep the weight off the affected joint. Certain exercises will be suggested by the doctor during recovery. There is a chance for Pigmented Villonodular synovitis recurring even after surgery. Hence, the patients need to watch out for any swelling and pain symptoms in the joints and report it to their doctor immediately.
