Indian doctors report a rare case of Synovial chondromatosis

Dr Prasanta Padhan and Dr Sakir Ahmed at Kalinga Institute of Medical Sciences, Bhubaneswar, India have reported a rare case of synovial chondromatosis. The case has appeared in the New England Journal of Medicine.

Synovial chondromatosis is a type of non-cancerous tumor that arises in the lining of a joint. The knee is most commonly affected, however it can affect any joint. The tumours begin as small nodules of cartilage. The exact underlying cause of synovial chondromatosis is unknown. Some research suggests that trauma may play a role in its development because the condition primarily occurs in weight-bearing joints. Infection has also been considered as a contributing factor.

A 46-year-old woman presented to the rheumatology clinic with a 3-month history of walking difficulty due to worsening knee pain. She had received a diagnosis of rheumatoid arthritis 12 years earlier but had received treatment inconsistently, with frequent changes between prescribed medical therapies and complementary medicine practices. On physical examination, she had nodular swelling and outward bowing of both knees.

She had a limited range of motion in her left shoulder and in both wrists and both knees. The number of swollen and tender joints, the disease activity score, and elevated C-reactive protein level were consistent with active rheumatoid arthritis. Radiographs of the knees showed multiple calcified loose bodies and narrowing of the joint space. These findings were consistent with synovial chondromatosis, a disorder of the synovium that is characterized by the development of loose cartilaginous bodies.

For the treatment of the rheumatoid arthritis flare, she was given methotrexate and folic acid with short-term glucocorticoids. The treatment of synovial chondromatosis can include surgery; however, the patient declined surgical evaluation. At follow-up 3 months later, her disease activity score for rheumatoid arthritis had decreased, and she had a moderate reduction in her knee pain and enhanced mobility with the use of a walker.