The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis

Nat Rev Rheumatol. 2010 Nov;6(11):625-35. doi: 10.1038/nrrheum.2010.159. Epub 2010 Oct 5.


Osteoarthritis (OA), one of the most common rheumatic disorders, is characterized by cartilage breakdown and by synovial inflammation that is directly linked to clinical symptoms such as joint swelling, synovitis and inflammatory pain. The gold-standard method for detecting synovitis is histological analysis of samples obtained by biopsy, but the noninvasive imaging techniques MRI and ultrasonography might also perform well. The inflammation of the synovial membrane that occurs in both the early and late phases of OA is associated with alterations in the adjacent cartilage that are similar to those seen in rheumatoid arthritis. Catabolic and proinflammatory mediators such as cytokines, nitric oxide, prostaglandin E(2) and neuropeptides are produced by the inflamed synovium and alter the balance of cartilage matrix degradation and repair, leading to excess production of the proteolytic enzymes responsible for cartilage breakdown. Cartilage alteration in turn amplifies synovial inflammation, creating a vicious circle. As synovitis is associated with clinical symptoms and also reflects joint degradation in OA, synovium-targeted therapy could help alleviate the symptoms of the disease and perhaps also prevent structural progression.

Publication types

  • Review

MeSH terms

  • Cartilage / diagnostic imaging
  • Cartilage / pathology
  • Cartilage / physiopathology
  • Disease Progression
  • Humans
  • Inflammation / physiopathology
  • Magnetic Resonance Imaging
  • Osteoarthritis / physiopathology*
  • Synovitis / diagnostic imaging
  • Synovitis / pathology
  • Synovitis / physiopathology*
  • Ultrasonography, Doppler