The outcome of knee synovitis in early arthritis provides guidelines for management

The aim of the study was to examine the clinical outcome of patients presen ting to an early arthritis clinic with synovitis of the knee. The patients were assessed at presentation for evidence and pattern of joint inflammatio n. These patients were then reassessed at 3, 6 and 12 months and thereafter annually to determine clinical outcome. One thousand six hundred and thirt y-three consecutive referrals were examined, 903 of whom had early synoviti s. One hundred and thirty had knee synovitis at presentation, of whom 73 fu lfilled ACR criteria for rheumatoid arthritis (RA) during the study. All 73 presented with a symmetrical polyarthritis that included the small joints and had persistent disease at 1 year. Of the remaining 57 patients, 61% of those presenting with an oligoarthritis and 33% with polyarthritis (includi ng knee synovitis) were in remission at 1 year. None of those presenting as monoarthritis of the knee had inflammation at 1 year or fulfilled ACR crit eria for RA at any time. It was concluded that patients presenting with kne e synovitis in the absence of a small joint polyarthritis usually have a be nign course following standard therapy. No patient who presented with monoa rthritis developed RA. Knee synovitis as part of a polyarthritis (even when not fulfilling ACR criteria) probably justifies disease-modifying antirheu matic drug at presentation.