How to Treat Rheumatoid Pannus

Just as inflammation can cause rheumatoid pannus tissue to develop, decreasing inflammation can cause the pannus to go away. Typically, the best approach is to decrease inflammation throughout the entire body, not just in the affected joint(s).

Most rheumatoid arthritis treatments address body-wide inflammation. These treatments will help reduce or eliminate pannus as well as other RA symptoms, such as fatigue. Rarely, surgery to remove pannus from a joint is recommended.

See Rheumatoid Arthritis (RA) Treatment

Rheumatoid Arthritis Drugs and Pannus

Medications are the first line of treatment for the rheumatoid arthritis inflammation that results in pannus tissue. These drugs either treat the symptoms of inflammation or stop inflammation from happening.

The medications prescribed to treat rheumatoid arthritis fall into 5 categories:

1. Non-steroidal anti-inflammatory drugs (NSAIDs)
2. Disease-modifying antirheumatic drugs (DMARDs)
3. Oral corticosteroids
4. Biologics
5. JAK inhibitors

Biologic drugs and JAK inhibitors are typically recommended only if the first 3 types of medications have failed to lower inflammation and decrease symptoms.

In general, if RA pannus does not go away, it is considered a sign that the medication regimen needs to be changed.

See 5 Types of Medication That Treat Rheumatoid Arthritis (RA)

Injections and RA Pannus

Sometimes rheumatoid arthritis medications are able to significantly reduce inflammation but pannus tissue, swelling, and pain persist in one or two joints. A corticosteroid injection into the joint(s) may decrease stubborn RA inflammation and eliminate or significantly reduce pannus tissue and the associated symptoms.

See Cortisone Injections (Steroid Injections)

Natural Home Remedies for Rheumatoid Arthritis Pannus

Many strategies for relieving the inflammation that leads to rheumatoid pannus can be done at home. These strategies sometimes require big lifestyle changes. They are typically recommended in addition to taking medications.

Research supports these natural home treatment strategies:

• Making changes to diet and eating more anti-inflammatory foods, such as high fiber fruits and vegetables^1-4
• Quitting smoking, vaping, and/or exposure to other toxins that trigger inflammation^5-9
• Getting regular exercise, which has been shown to reduce inflammation^10-
• Improving sleep habits, which may boost the immune system function¹³ and keep inflammation in check^14-16
• Using stress-reducing strategies, such as meditation, nature walks, or listening to music, which may limit the body’s release of stress hormones, which contribute to inflammation^17,18
• Nurturing positive social relationships and limiting negative ones that can increase stress and inflammation levels^19-21

See Dietary Supplements for Treating Arthritis

Limited evidence from small studies also suggests that certain supplements, such as turmeric and ginger, may reduce inflammation in some people.^22-27 Before taking a supplement, consult with a physician or pharmacist about possible drug interactions. Stop taking a supplement if benefits do not appear within 3 to 6 months.

When Surgery (Synovectomy) Is Recommended

If rheumatoid pannus does not go away with medications or injections, surgery to remove the inflammatory tissue may be recommended. This surgery is called synovectomy.

While rarely recommended, synovectomy can help relieve symptoms such as pain and stiffness in joints such as the knee,²⁸ elbow,²⁹ and wrist.³⁰ Synovectomy does not seem to have much effect on body-wide (systemic) inflammation that can be measured by blood tests.³¹

The benefits of synovectomy may last years. Studies of synovectomy in the knee found benefits lasted 3 to 5 years.^32,33 Another study examining synovectomy in the elbow found that benefits lasted 10 years or longer in some patients, potentially allowing them to postpone joint replacement surgery.²⁹

Synovectomy may be done in one of two ways:

1. An open synovectomy uses a single, large incision in the skin over the joint. The advantage of this approach is that more pannus tissue can be removed and results seem to last longer. However, the surgeon must cut through muscle and other soft tissues, making the recovery period longer and less comfortable.
2. An arthroscopic synovectomy involves making just a few small (typically 1 cm) incisions. The small incisions involve less cutting of soft tissues. Recovery tends to be faster and easier. However, the surgeon may not be able to remove as much pannus during an arthroscopic procedure.

One study³⁴ suggests that pannus is more likely to grow back in joints that have undergone arthroscopic synovectomy.

While not all physicians agree,³⁴ some recommend that synovectomy be done in the early stages of RA, before much joint damage has taken place.

Read more about Surgery for Rheumatoid Arthritis (RA)