[Practical experiences in the intra-articular treatment of chronic rheumatic diseases]

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.