Lady Gaga has been in the news a lot recently, but not for the reasons that you might think. Instead of talking about her music, or her fashion sense, most news outlets have been reporting on the fact that Lady Gaga had to cancel some of her tour dates because of a condition known as “synovitis” affecting her hip. For this reason, this week I thought I’d write about synovitis to shed some light on this condition.

What is Synovitis?

Synovitis is a joint disorder that can occur in many joints other than the hip, including the shoulder, hand, wrist, knee, and especially the ankle and the joints in the foot. It is an inflammation of a special kind of tissue that lines these joints, called the synovial membrane. This membrane is very important because it produces a fluid that acts as a lubricant that helps the joint move. When the membrane is inflamed, the joint becomes swollen with this fluid, and is often very painful.

What causes it?

Synovitis can arise after an injury, or it can occur secondary to other conditions such as arthritis and gout.

What are the symptoms?

Symptoms of synovitis include joint swelling, warmth, redness, and pain, especially when moving the joint.

How is it treated?

Over the counter medications like aspirin and ibuprofen may work in some cases to relieve pain and swelling. For more severe cases either oral or injectable steroids may be indicated. Surgery is rarely necessary, and reserved only for persistent cases.

Unfortunately for Lady Gaga, it was reported that her problems were more severe than just synovitis. She recently underwent surgery to repair a soft tissue tear in one of the structures of her hip joint; with this type of surgery, she will most likely face a lengthy recovery period.

Eric Polansky, DPM

If you watch TV, chances are you’ve seen the commercial with the middle-aged gentleman carrying around a large vial partially filled with a green liquid.  The advertisement is for a new medication designed for the treatment and prevention (prophylaxis) of gout. To my knowledge, Uloric is the first medication to be approved by the FDA for gout prophylaxis in approximately 30 years.  This commercial has caused an increased awareness as well as a concern to many people who have had pain in their feet that they believe may be attributed to gout.

While this particular advertisement focuses on the big toe joint, which is the most common area, gout can occur nearly anywhere in the body.  I have personally seen gout attack non-joint areas such as the web spaces just above the toes.  Gout is precipitated by a high amount of uric acid in the blood that will leak out of the bloodstream and typically settle in a joint.  Upon settling it becomes crystallized into condensed bunches called tophi. 

 Acutely this will cause the affected area to be swollen, hot, red, and painful.  Many patients relate that anything that touches the area, even the rubbing of a sheet across the area will cause severe pain.  Chronically, long after the acute pain is gone, the gouty tophi can erode the joint surface causing arthritic pain to the area.

This type of arthritis is on the rise – particularly among men.  More than 8 million people have it, and the rates have doubled in the last 50 years.  Gout is no respecter of persons.  It can strike anyone including famous people and professional athletes. When he wasn't lopping off his wives' heads, King Henry VIII of England was coping with attacks of gout.  David Wells, the left-handed pitcher who played for the New York Yankees and Toronto Blue Jays has struggled with gout throughout his baseball career.  Maurice Cheeks, coach of the Philadelphia 76ers and Portland Trail Blazers, who played 15 seasons in the NBA with 4 All-Star appearances, was 46 when he started experiencing severe pain secondary to gout. 

How is it treated? At Advanced Foot & Ankle Care Centers of Ohio we typically will treat an acute flare of gout with a cortisone injection to the area.  This has been found to give the most relief the fastest. Other medications that help are non-steroidal anti-inflammatories such as Indomethacin.  Colchicine is another effective medication but is not prescribed as often as is commonly causes severe diarrhea.  I will usually check the blood uric acid level.  If it is elevated I will give the patient the option of taking a long-term medication such as Uloric or Allopurinol that will decrease the amount of uric acid in the bloodstream. Either one of these medications must be taken on a daily basis to help prevent future arthritis due to gout as well as the recurrence of a gout attack.  If you feel that you may have gout or have had gout in the past and would like to discuss options for treatment, please feel free to make an appointment at any one of our 4 locations in Huber Heights, Troy, Piqua, or Sidney.

Dr. Jeff Carlson