|Latin||membrana synovialis capsulae articularis|
The synovial membrane (also known as the synovial stratum, synovium or stratum synoviale) is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath.It makes direct contact with the fibrous membrane on the outside surface and with the synovial fluid lubricant on the inside surface. In contact with the synovial fluid at the tissue surface are many rounded macrophage-like synovial cells (type A) and also type B cells, which are also known as fibroblast-like synoviocytes (FLS). Type A cells maintain the synovial fluid by removing wear-and-tear debris. As for the FLS, they produce hyaluronan, as well as other extracellular components in the synovial fluid.
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The synovial membrane is variable but often has two layers
Where the underlying subintima is loose, the intima sits on a pliable membrane, giving rise to the term synovial membrane.
This membrane, together with the cells of the intima, provides something like an inner tube, sealing the synovial fluid from the surrounding tissue (effectively stopping the joints from being squeezed dry when subject to impact, such as running).
Just beneath the intima, most synovium has a dense net of fenestrated small blood vessels that provide nutrients not only for synovium but also for the avascular cartilage.
In any one position, much of the cartilage is close enough to get nutrition directly from the synovium.
Some areas of cartilage have to obtain nutrients indirectly and may do so either from diffusion through cartilage or possibly by 'stirring' of synovial fluid.
The surface of synovium may be flat or may be covered with finger-like projections or villi, which, it is presumed, help to allow the soft tissue to change shape as the joint surfaces move one on another.
The synovial fluid can be thought of as a specialised fluid form of synovial extracellular matrix rather than a secretion in the usual sense.The fluid is transudative in nature which facilitates continuous exchange of oxygen, carbon dioxide and metabolites between blood and synovial fluid. This is especially important since it is the major source of metabolic support for articular cartilage. Under normal conditions synovial fluid contain <100/mL of leucocytes in which majority are monocytes.
The intimal cells are of two types, fibroblast-like synoviocytes or type B cells and macrophage-like synovial cells. Surface cells have no basement membrane or junctional complexes denoting an epithelium despite superficial resemblance.
|Synovial cell||Resemble||Prominent organelle||Function|
|Type B||Fibroblast||Endoplasmic reticulum||Secrete hyaluronic acid, & proteins complex (mucin) of synovial fluid|
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Although a biological joint can resemble a man-made joint in being a hinge or a ball and socket, the engineering problems that nature must solve are very different because the joint works within an almost completely solid structure, with no wheels or nuts and bolts.
In general, the bearing surfaces of manmade joints interlock, as in a hinge. This is rare for biological joints (although the badger's jaw interlocks).
More often the surfaces are held together by cord-like ligaments. Virtually all the space between muscles, ligaments, bones, and cartilage is filled with pliable solid tissue. The fluid-filled gap is at most only a twentieth of a millimetre thick. This means that synovium has certain rather unexpected jobs to do. These may include:
Synovium can become irritated and thickened (synovitis) in conditions such as osteoarthritis,Ross River virus or rheumatoid arthritis (RA). The fibroblast-like synoviocytes (FLS) play a key role in the pathogenesis of RA, and the aggressive phenotype of FLS in RA and the effect these cells have on the microenvironment in the joint can be summarized into hallmarks that distinguish them from healthy FLS. These hallmark features of FLS in RA are divided into 7 cell-intrinsic hallmarks (such as reduced apoptosis and impaired contact inhibition) and 4 cell-extrinsic hallmarks (such as their ability to recruit and stimulate immune cells) .
In general, inflamed synovium is accompanied by extra macrophage recruitment (as well as the existing type A cells), fibroblast proliferation and an influx of inflammatory cells including lymphocytes, monocytes and plasma cells.When this happens, the synovium can interfere with the normal functioning of the joint. Excessive thickened synovium, filled with cells and fibrotic collagenous tissue, can physically restrict joint movement. The synovial fibroblasts may make smaller hyaluronan so it is a less effective lubricant of the cartilage surfaces. Under stimulation from invading inflammatory cells, the synovial cells may also produce enzymes (proteinases) that can digest the cartilage extracellular matrix. Fragments of extracellular matrix can then further irritate the synovium.
The word synovium is related to the word synovia in its sense meaning "synovial fluid". The latter was coined by Paracelsus.More information is given at Synovial fluid § Etymology and pronunciation .
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.
Cartilage is a resilient and smooth elastic tissue, a rubber-like padding that covers and protects the ends of long bones at the joints, and is a structural component of the rib cage, the ear, the nose, the bronchial tubes, the intervertebral discs, and many other body components. It is not as hard and rigid as bone, but it is much stiffer and much less flexible than muscle. The matrix of cartilage is made up of glycosaminoglycans, proteoglycans, collagen fibers and, sometimes, elastin.
In biology, the extracellular matrix (ECM) is a three-dimensional network of extracellular macromolecules, such as collagen, enzymes, and glycoproteins, that provide structural and biochemical support to surrounding cells. Because multicellularity evolved independently in different multicellular lineages, the composition of ECM varies between multicellular structures; however, cell adhesion, cell-to-cell communication and differentiation are common functions of the ECM.
A synovial joint, also known as diarthrosis, joins bones with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones' articulating surfaces. The synovial cavity/joint is filled with synovial fluid. The joint capsule is made up of an outer layer, the articular capsule, which keeps the bones together structurally, and an inner layer, the synovial membrane, which seals in the synovial fluid.
Synovial fluid, also called synovia,[help 1] is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.
Hyaline cartilage is the glass-like (hyaline) but translucent cartilage found on many joint surfaces. It is also most commonly found in the ribs, nose, larynx, and trachea. Hyaline cartilage is pearl-grey in color, with a firm consistency and has a considerable amount of collagen. It contains no nerves or blood vessels, and its structure is relatively simple.
Loose connective tissue is a category of connective tissue which includes areolar tissue, reticular tissue, and adipose tissue. Loose connective tissue is the most common type of connective tissue in vertebrates. It holds organs in place and attaches epithelial tissue to other underlying tissues. For example, it forms telae, such as the tela submucosa and tela subserosa, which connect mucous and serous membranes to the muscular layer. It also surrounds the blood vessels and nerves. Cells called fibroblasts are widely dispersed in this tissue; they are irregular branching cells that secrete strong fibrous proteins and proteoglycans as an extracellular matrix. The cells of this type of tissue are generally separated by quite some distance by a gelatinous substance primarily made up of collagenous and elastic fibers.
Hyaluronic acid, also called hyaluronan, is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglycans in that it is nonsulfated, forms in the plasma membrane instead of the Golgi apparatus, and can be very large: human synovial HA averages about 7 million Da per molecule, or about 20000 disaccharide monomers, while other sources mention 3–4 million Da. As one of the chief components of the extracellular matrix, hyaluronan contributes significantly to cell proliferation and migration, and may also be involved in the progression of some malignant tumors.
Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface, or on a prosthetic heart valve. Pannus may grow in a tumor-like fashion, as in joints where it may erode articular cartilage and bone.
Synovitis is the medical term for inflammation of the synovial membrane. This membrane lines joints that possess cavities, known as synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to synovial fluid collection.
Synovial chondromatosis is a disease affecting the synovium, a thin flexible membrane around a joint.
In anatomy and histology, the term wandering cell is used to describe cells that are found in connective tissue, but are not fixed in place. This term is used occasionally and usually refers to blood leukocytes in particular mononuclear phagocytes. Frequently, the term refers to circulating macrophages and has been used also for stationary macrophages fixed in tissues (histiocytes), which are sometimes referred to as "resting wandering cells".
Synovectomy is a procedure where the synovial tissue surrounding a joint is removed. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone. If arthritis is not controlled, it can lead to irreversible joint damage. The synovial membrane or "synovium" encloses each joint and also secretes a lubricating fluid that allows different joint motions such as rolling, folding and stretching. When the synovium becomes inflamed or irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.
Aggrecan (ACAN), also known as cartilage-specific proteoglycan core protein (CSPCP) or chondroitin sulfate proteoglycan 1, is a protein that in humans is encoded by the ACAN gene. This gene is a member of the lectican family. The encoded protein is an integral part of the extracellular matrix in cartilagenous tissue and it withstands compression in cartilage.
Osteoimmunology is a field that emerged about 40 years ago that studies the interface between the skeletal system and the immune system, comprising the “osteo-immune system”. Osteoimmunology also studies the shared components and mechanisms between the two systems in vertebrates, including ligands, receptors, signaling molecules and transcription factors. Over the past decade, osteoimmunology has been investigated clinically for the treatment of bone metastases, rheumatoid arthritis (RA), osteoporosis, osteopetrosis, and periodontitis. Studies in osteoimmunology reveal relationships between molecular communication among blood cells and structural pathologies in the body.
Chitinase-3-like protein 1 (CHI3L1), also known as YKL-40, is a secreted glycoprotein that is approximately 40kDa in size that in humans is encoded by the CHI3L1 gene. The name YKL-40 is derived from the three N-terminal amino acids present on the secreted form and its molecular mass. YKL-40 is expressed and secreted by various cell-types including macrophages, chondrocytes, fibroblast-like synovial cells, vascular smooth muscle cells, and hepatic stellate cells. The biological function of YKL-40 is unclear. It is not known to have a specific receptor. Its pattern of expression is associated with pathogenic processes related to inflammation, extracellular tissue remodeling, fibrosis and solid carcinomas and asthma.
Proteoglycan 4 or lubricin is a proteoglycan that in humans is encoded by the PRG4 gene. It acts as a joint/boundary lubricant.
A rheumatoid nodule is a local swelling or tissue lump, usually rather firm to touch, like an unripe fruit, which occurs almost exclusively in association with rheumatoid arthritis. Very rarely rheumatoid nodules occur as rheumatoid nodulosis in the absence of arthritis. They are usually subcutaneous especially over bony prominences such as the olecranon or the interphalangeal joints. Less commonly they occur in the lining of the lung and other internal organs. The occurrence of nodules in the lung of miners exposed to silica dust was known as Caplan's syndrome. Nodules vary in size from that of a lentil or pea to that of a mandarin orange. Quite often they are associated with synovial pockets or bursae. About 5% of rheumatoid arthritis patients have such nodules within two years of disease onset, and the cumulative prevalence is about 25%. In the great majority of cases nodules are not painful or disabling in any way, being more of an unsightly nuisance, but in some cases they can be painful, especially if the overlying skin breaks down. Rarely, the nodules occur at diverse sites on body.
Fibroblast-like synoviocytes (FLS) represent a specialised cell type located inside joints in the synovium. These cells play a crucial role in the pathogenesis of chronic inflammatory diseases, such as rheumatoid arthritis.
Gene transfer strategies for the potential medical management of osteoarthritis are under preliminary research to define pathological mechanisms and possible treatments for this chronic disease. Unlike pharmacological treatments which are administered systemically, gene therapy aims to establish sustained, synthesis of gene products and tissue rehabilitation within the joint.