Arthroscopic treatment of rheumatoid synovitis

Arthroscopic synovectomy (AS) as a therapeutic modality in the treatment of chronic rheumatoid synovitis of the knee joint refractory to disease-modifying anti-rheumatic drugs (DMARDs) still enjoys an unflagging interest. Synovectomy has a lasting beneficial effect on the local manifestations of the rheumatoid inflammation. The purpose of the study was to evaluate the long-term results of arthroscopic synovectomy of knee joint combined with tidal lavage in patients with chronic rheumatoid synovitis included in a 5-year prospective study.

84 patients (13 men, 71 women, mean age 45.3 +/- 14.7 yrs) with rheumatoid arthritis (RA) received a partial arthroscopic synovectomy. The diagnosis was made according to the criteria of the American College of Rheumatology (ACR) (1987). All patients received active treatment with DMARDs for at least 3 months prior to the arthroscopic synovectomy. Local treatment with corticosteroids was also administered without any lasting effect. The synovectomy was performed under local anesthesia with motorized shaver and followed by tidal lavage with 6-8 liters of saline solution. All synovectomies were performed by one and the same team of rheumatologists. The result of the synovectomy was assessed using the Knee Assessment Questionnaire (KAQ8); the patients' functional status was assessed by mHAQ20 and Disability mHAQ04.

After the AS there was a significant improvement in the KAQ8 indices: pain relief, improvement of the knee joint function, reduction of the symptoms of local joint lesion and of the parameters of self-care restriction. This beneficial effect held throughout all 60 months of follow up and only started to weaken at the end of this period. The mHAQ20 scores after AS remained significantly lower even 60 months after AS, and the Disability mHAQ04 scores remained on the level before AS. These results indicate the presence of beneficial effect from AS on the general functional status and the parameters of disability of patients studied.

Arthroscopic synovectomy combined with tidal lavage of the knee joint is a major therapeutic modality in the treatment of chronic synovitis in RA. Arthroscopic synovectomy of the knee joint significantly and for a long period of time relieves pain in the operated joint, improves the joint function, reduces the symptoms of the local joint lesion, decreases general disability and improves the capacity for self care.