What is pannus?

Rheumatoid arthritis (RA) is an autoimmune disease that causes your body’s immune system to attack your joints. This causes swelling, pain, and pannus — an abnormal tissue growth in the joints.

This tissue can spread to your bones and cartilage, causing cartilage destruction, bone deterioration, pain, and inflammation.

Though this disorder can affect any joint in the body, those usually affected in RA are the joints of the hands, wrists, and fingers.

When RA attacks your joints, it also attacks the surrounding tissues. The tissue that lines your joints is the synovial membrane or the synovium. The normal synovium that lubricates your joints is only a few blood cells thick.

When you develop RA, your white blood cells attack the synovium, releasing proteins that cause blood vessels in the synovium to multiply. This increased blood flow encourages tissue growth at an accelerated rate.

In response, your synovial membrane will thicken and take over the small space between your joints and bones. The pannus can become rough and irregular and will eventually cover your bones and cartilage.

During the early stages of RA, pannus is more likely to grow in small joints, such as the wrists, hands, and feet.

Pannus can also grow in the eye cornea, prosthetic heart valve, and abdomen. Over time, it can resemble a tumor and may form in larger joints during later stages of the disease, including the knees or shoulders.

Pannus growth can cause bone and cartilage damage over time. Without proper treatment, it can cause:

  • pain
  • irreversible damage to your tendons
  • damage to bone marrow
  • bone deterioration
  • permanent deformity

Pannus can also cause excess fluid production.

Your synovial membrane produces small amounts of fluid to keep your joints lubricated. If pannus grows, it also produces more fluid. This can cause inflammation, joint swelling, and tissue deterioration.

Treatment for RA depends on the severity of your condition. Nonsteroidal anti-inflammatory drugs (NSAIDs) are common treatment options that help to reduce pain and inflammation. NSAIDs are available as a pill, skin patch, or topical.

Doctors may prescribe corticosteroid medication to decrease inflammation and help slow pannus growth. Some common corticosteroid drugs used for RA include:

Your doctor will only recommend these drugs in the short term. Though effective, corticosteroids can cause a number of side effects over time, including:

Medication

More definitive treatment for RA consists of disease-modifying antirheumatic drugs (DMARDs) and targeted biologic agents. Doctors prescribe these medications in the treatment of RA in an effort to prevent joint destruction.

DMARDs are used to block inflammation and prevent further joint damage. There are different types of DMARDs, and each may work differently.

Hydroxychloroquine, available as an oral supplement, is a DMARD originally used to treat malaria, and now to treat lupus, Sjogren’s, and RA. It reduces swelling from RA and may also help prevent joint damage.

Researchers are trying to further understand why it’s effective, but it’s known that hydroxychloroquine decreases inflammatory proteins (cytokines) and inhibits early activation steps in the immune response.

Methotrexate is one of the oldest DMARDs and still the “gold standard.” Once in the system, this drug converts to methotrexate polyglutamate to reduce swelling and inflammation.

Other DMARDs are:

Another class of DMARDs is biologics. Biologics used to treat RA include:

Steroids are sometimes also injected into joints to provide quick relief from symptoms, especially when treatment is first initiated, as most medications take several weeks to work.

These injections provide targeted pain relief to one or two joints with minimal short-term side effects. However, the effectiveness of these treatments can decrease over time, and taking steroids continuously for long periods can cause negative side effects.

In more serious cases, your doctor may recommend surgery to replace the affected joints or remove the pannus (through synovectomy). This restores mobility and relieves pain. In the joint replacement procedure, your doctor replaces your damaged joints with metal and plastic parts.

Home remedies

There are several ways to help reduce symptoms of RA at home.

Managing choices in your diet and lifestyle is an effective way to minimize symptoms. In fact, one 2017 study found that 24 percent of people with RA reported that diet had a significant impact on their symptoms.

For this reason, eating a variety of anti-inflammatory foods and regularly practicing low-impact exercises like walking or swimming may be beneficial. Some research also suggests that activities like yoga or tai chi could provide symptom relief and improve quality of life.

You may also want to consider applying a hot or cold compress to your joints to reduce pain, stiffness, and swelling. Your doctor can provide personalized guidance on which specific treatment is right for you.

Other complementary therapies like acupuncture and massages may also be beneficial, but more research is needed.

RA causes joint pain because of inflammation and the growth of pannus. This leads to cartilage destruction, bone deterioration, loss of joint function, and loss of mobility.

Treatment options include anti-inflammatory medications, disease-modifying medications, targeted treatment with biologics, and surgical options.

You can also take an active role in your treatment with some self-care practices. Maintaining a diet rich in antioxidants can reduce joint inflammation. Proper rest can also protect your joints from overuse and lessen major swelling.

If you begin to experience any discomfort within your joints, call your doctor to get an accurate diagnosis and discuss treatment options.