Should patients with active synovitis undergo elective surgery?
Usually they should not. Patients with active synovitis may have significant pain in the postoperative period from their arthritis that impairs functional status, impedes progress with rehabilitation, and prolongs hospitalization. Patients with active synovial disease and its consequent disability should have the inflammation controlled as much as possible prior to elective surgical procedures. If a patient does have active disease in the perioperative period and systemic corticosteroids or DMARDs are inadvisable, intraarticular corticosteroids may be considered. Notably, intraarticular steroids in a joint that is being considered for arthroplasty or other surgery may lead some orthopedic surgeons to delay surgery; as such, it is important to consult with the orthopedic surgeon before injecting a joint being considered for surgery.