Histopathological Spectrum of Synovitis in a Tertiary Care Hospital: A Cross-Sectional Study

Authors

  • Rashi Maheshwari Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
  • Rajni Prasad Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
  • Priyadharshini Bargunam Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.21276/apalm.3836

Keywords:

synovitis, synovial biopsy, histopathology, septic arthritis, tubercular synovitis, knee joint

Abstract

Introduction Synovitis is a common manifestation of diverse inflammatory and non-inflammatory joint disorders. While clinical, radiological, and serological investigations aid diagnosis, they may be inconclusive, necessitating histopathological evaluation. Synovial biopsy remains the gold standard for etiological classification of synovitis. This study aimed to assess the histopathological spectrum of synovitis at a tertiary care hospital.

Methods A cross-sectional study was conducted over 18 months, including 130 synovial biopsy specimens. Biopsies obtained by open or image-guided techniques were fixed in 10% neutral buffered formalin, routinely processed, and stained with hematoxylin and eosin. Special stains were performed where required. Data were analyzed using descriptive statistics.

Results The mean age of patients was 33.06 ± 18.6 years, with a male predominance (60%). The knee joint was the most commonly involved site. Histopathological evaluation revealed septic arthritis as the most frequent diagnosis (29.23%), followed by tubercular synovitis (22.31%) and chronic non-specific synovitis (20%). Osteoarthritis (11.54%), rheumatoid arthritis (5.38%), and other less common entities constituted the remainder.

Conclusion Synovitis demonstrates a wide histopathological spectrum, with infectious etiologies predominating in this cohort. Histopathological examination of synovial biopsy plays a pivotal role in definitive diagnosis and guides appropriate patient management.

References

1. Rajesh G, Patil S, Ranganath N. Study of histomorphological features of synovial biopsy in joint diseases. Ind J Pathol Oncol. 2019;6(4):636–41.

2. Sellam J, Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat Rev Rheumatol. 2010;6(11):625–35.

3. Mussawy H, Zustin J, Luebke AM, Strahl A, Krenn V, Rüther W et al. The histopathological synovitis score is influenced by biopsy location in patients with knee osteoarthritis. Arch Orthop Trauma Surg. 2021;142(11):2991–2997.

4. Tijoriwala P, Moradiya N, Shah S. Study of analysis of Synovial Biopsy of Knee Joint for various Diseases And Its Correlation With Laboratory And Clinical Findings. Int J Sci Res. 2019;8(7).

5. Krenn V, Morawietz L, Burmester GR, Kinne RW, Mueller-Ladner U, Muller B, et al. Synovitis score: discrimination between chronic low-grade and high-grade synovitis. Histopathology. 2006;49(4):358-64.

6. Layton C, Bancroft JD. The hematoxylin and eosin. In: Bancroft JD, Gamble M, editors. Bancroft's theory and practice of histological techniques. 7th ed. Edinburgh: Churchill Livingstone Elsevier; 2013. p. 173-86.

7. Morawietz L, Fernahl G, Krenn V. Differential diagnosis of synovitis. Pathologe 2006;27:402-8.

8. Knöss P, Knöss M, Otto M, Kriegsmann J, Krukemeyer MG, Krenn V. Das differenzialdiagnostische Spektrum der Synovialitis [Diagnostic spectrum of synovitis]. Z Rheumatol. 2008;67(1):8-16.

9. Singh V, Ganapathy H, Thanka J. Synovial Fluid Analysis and Biopsy in Diagnosis of Joint Diseases. J Pharm Res Int. 2016;33(22B):1-1.

10. Kulkarni MM, Khandeparkar SG, Joshi AR, Patil S, Lengare P. Clinicopathological study of synovial biopsies at tertiary care hospital and its diagnostic utility. Ind J Pathol Onco. 2017;4(4):595-9.

11. Khanna V, Khanna M, Kapoor R. Histomorphological study of synovial lesions. Int J Orthop Sci. 2019;5(4):845-8.

12. Schmidt T, Najm A, Mussawy H, Burghardt R, Oehler N, Krenn V et al. General synovitis score and immunologic synovitis score reflect clinical disease activity in patients with advanced stage rheumatoid arthritis. Sci Rep. 2019;9:8448.

13. Mundla GK, Rallapalli R, Galla SS, Ravindran B. A prospective study for diagnosing joint diseases by synovial fluid analysis and percutaneous needle biopsy of synovium. Int J Res Orthop. 2017;3(4):661-9.

14. Rabquer BJ, Tan GJ, Shaheen PJ, Haines GK 3rd, Urquhart AG, Koch AE. Synovial inflammation in patients with osteonecrosis of the femoral head. Clin Transl Sci. 2009;2(4):273–8.

15. Garaffoni C, Tamussin M, Calciolari I, Lanza G, Bortoluzzi A, Scirè CA, et al. High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study. Front Immunol [Internet]. 2023;14:1298583.

Downloads

Published

01-06-2026

Issue

Section

Original Article

How to Cite

1.
Histopathological Spectrum of Synovitis in a Tertiary Care Hospital: A Cross-Sectional Study. Ann of Pathol and Lab Med [Internet]. 2026 Jun. 1 [cited 2026 Jun. 2];13(6):A307-A312. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3836