What is synovial fluid?
Synovial fluid is a lubricant lies within your joints and protects your bones from clashing together when you're moving. When you injure yourself, there is often swelling to protect yourself even more. However, with Rheumatoid Arthritis, your disease fills up the joint quite excessively to "protect" yourself. Since the disease is idiopathic, it thinks it is helping to protect you when in reality the fluid is excessive and causes damage to the cartilage and bones through infection if it is not extracted in a timely manner.
Any joint can fill up excessively with fluid in a flare up. The most common joints that show a Rheumatoid Arthritis flare are the hands and knees. It is extremely important that you have this fluid extracted. Essentially, if you keep the fluid in the joint for too long, it becomes infected. The way doctors know if your joint has been infected from the synovial fluid is if, in extraction, they find the liquid to be cloudy.
Synovial fluid looks like the color and consistency of urine from someone who is not well-hydrated. If it is not infectious, it will be clear, but bright yellow. If it is infectious, it will still be bright yellow, but you will not be able to see the hash marks, or mL measurement marks of the syringe.
Extraction of Synovial Fluid-- Does it hurt?
Patients who have had RA for years, have a higher pain tolerance than most. With that being said, yes-- it still hurts. However, it is more uncomfortable than it is painful. The most painful part of synovial fluid extraction is the last 10 seconds, where the doctor is trying to find the last sacs of fluid before they pull the needle out. In these situations, it is common for them to hit a nerve or bone, which sends pains all up and down your body. In a situation like this, it is important that you remain calm and do not move quickly, as the needle needs to be pulled out in a specific angle.
Studies have proven that having synovial fluid extracted from the side of the knee creates less chances of the needle contact area to become infected. In addition, doctors have found that more fluid can be drawn from various areas if you pull from the side of the knee.
What is the most painful part of an Arthritis flare up?
In my opinion, the most painful part of the flare up is when the local anesthesia when the joint is already reached extreme swelling. At this time, the joint is beyond full with fluid, with minimal range of motion due to the swelling. As if that was not painful enough, inserting anesthesia into the joint ads more pressure to the joint. Your skin is stretched out further than it has already gone, feeling as if your knee is about to pop. It feels as if you are fully diated in the knee and need to pop that thing out, meaning the fluid. Once the fluid is extracted, your knee can be sore. Adding in a steroidal injection, such as cortisone, can also be very painful. From my opinion, after the traumatizing experience of the extraction, the last thing I want is anything else in my knee. The seroid can burn and usually it lasts for about a day.
Does it take time to heal after a flare up?
Yes. It is important that you give yourself time to rest. A flare up means that your body has just been in "beast mode", meaning that you have been spending more spoons, trying to fight something off. Your energy should be low. As for your knee, in this example, you must not go out of your doctor's office and put pressure on the knee. Use crutches, ice on and off using the golden rule of "20 minutes on, 30 minutes off".
How do I know if I'm having a flare up?
Check your range of motion. If you feel that you cannot bend your knee 2/3 of the way to your but, if you feel stiff, and if you have seen the size of your thigh, knee, and/or foot greatly increase in a short span of time, you will want to get to a hospital as soon as possible, as you are most likely having a flare up.
Where do I have the synovial fluid extracted?
While at work, I called six different urgent cares in the area of Portland, Oregon. From what I understand, most medical practices do not have the necessary or experienced medical practitioner to perform the extraction. Instead of setting up an appointment over the phone and/or showing up to an urgent care, it is important that you ask if they have capacity.
Most of the time, you will need to see your Rheumatologist to have the extraction. The amount of time it takes to perform the procedure ranges. From my experience, it goes fairly quick and most doctors can fit you in, as they understand the importance of extracting the fluid as soon as they can before it becomes infected. It does not take long-- probably 20 minutes including checking your vitals, asking a few questions, setting up the syringes, giving the local anesthesia, and extracting it. Local anesthesia is spray that is inserted onto the top layer of skin that helps to minimize the amount of pain felt from the needle point, which is fairly large.
How big is the needle?
My doctor likes to call the needle, "the little guy", because in all honesty, you need to have a little humor when it comes to the extraction process. When you have almost 2 ounces extracted at a time, you want to try and do it as quickly as possible, primarily because of the discomfort and pain. In addition, the more time a foreign object is in your body, the higher risks of your body rejecting it. With RA, you have to be careful with needles, in general, because you are prone to infections more than the average patient.