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Local instillations of various medicaments with the aim of a so-called chemical synovectomy are compared with the experiment of a possible causal therapy by operative synovectomy. Under this aspect corticosteroids are used still relatively frequently also for the intraarticular treatment. They diminish transiently the inflammation of the pannus, but they do not remove it. On the basis of its good local compatibility in relapsing effusions of the large articulations, mostly of the knee-joints, which appeared in the course of a chronic progressive rheumatoid arthritis of Bechterew's disease, cyclophosphamide was applied intraarticularly and was compared with the results after injections of prednisolone. Apart from the clinical findings cytological and biochemical examinations of the synovial membrane, which more exactly than clinical parameters allow an objective estimation of the local inflammatory activity, were used for the judgement of the success. With the help of intraarticular treatment of cyclophosphamide within a complex chemotherapy an improvement of the findings and a stabilisation of the process can be achieved. Local applications of prednisolone often lead to a rapid, however, in most cases not remaining reduction of the activity at the joint. In uninfluencable high local activity of the process, objectified by examinations of the synovial membrane, an early synovectomy is indicated for the prevention of the formation of irreversible chondropathies.

Activity and results of therapy of joint diseases can be evaluated by means of cytological examinations of the synovia which is at the same time a prerequisite for differential diagnosis using the puncture fluid. Our cytological examinations of more than 700 puncture fluids stemming from different joint diseases were carried out immediately after the puncture on the fresh material, in order to prevent misinterpretation. This may occur through flaking out in stored material, which results in decrease in the cell count and a non-representative differential cell picture in the supernatant, as well as through degeneration of cells. In two thirds of our patients the local process activity, measured in terms of the cytological phase of activity, became evident in the total clinical activity. The synovia analysis furthermore permits objective assessment of the result of intra-articular injection treatment. Intractable activity, substantiated through synovia examination indicates synovectomy.

The synovial milieu in uric arthritis is characterized with the help of own findings of examinations and data in literature. Apart from the mean values of cytological and biochemical findings of the synovia the changes under therapy are described on the basis of individual examples. The formation of monosodium urate crystals seems to be the starting point of the inflammatory joint process in gout. The size of the arthritic syndrome is among others determined by the local metabolic process, in which case lactate acidosis and reduction of energy as well as the increase of enzyme activities seem to stand in the foreground.