Sidor Michael L MD

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Mon - Fri:	9:00 am - 5:00 pm

Sidor Michael L MD

General Practitioners

Arthritis
One thing that the diffuse form of PVNS has in common with the nodular form is that it is often misdiagnosed initially. The former may be even harder to diagnose than the latter because it does not have a discrete, nodular soft tissue mass as its calling card. Diffuse PVNS is almost always an entirely painless disease, at least in its early stages, and it most commonly presents itself as simple knee swelling caused by an excessive accumulation of synovial fluid within the joint. This excess fluid is secreted by the overgrown joint lining tissue. Unless the quantity of fluid in the joint becomes so great as to stretch the joint capsule and cause discomfort, patients often regard this as more of an annoying curiosity than a significant problem at first. Patients who present for medical evaluation find that their knee x-rays are almost always normal and that all of their blood tests are negative for diseases like rheumatoid arthritis, lyme disease, lupus, etc. Clinicians should always keep in mind the possibility of PVNS when presented with a patient who is suffering from unexplained, recurrent fluid accumulations in one of their joints, especially when the joint fluid has a slightly more orange-brown color to it than normal. Sometimes the delicate, overgrown joint lining tissue bleeds intermittently and thus even red joint fluid may be found at times. The presence of diffuse PVNS is verified by direct arthroscopic inspection of the interior of the joint and taking a synovial tissue biopsy. Microscopic tissue analysis is required to make a firm pathologic diagnosis. Once this has been confirmed, treatment must be planned.

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