Arthroscopic synovectomy of the wrist in rheumatoid arthritis

Abstract

We analysed the results of arthroscopic synovectomy of the wrist in 18 patients (19 wrists) with rheumatoid arthritis who had not responded to conservative treatment. The patients' symptoms were assessed using visual analogue scales for pain and satisfaction. Standard posteroanterior radiographs which were taken pre-operatively and at final follow-up were analysed using a modified Larsen scoring system (normal, 0; total destruction, 40). The mean follow-up period was 29.2 months (24 to 45). The mean pre-operative pain score was 8.58 which decreased to 3.58 one year after surgery and increased again to 4.42 at final follow-up. This suggested a gradual increase in pain with time. The mean satisfaction score was 6.26. The mean modified Larsen's score was 9.8 pre-operatively and 13.9 at final follow-up, which demonstrated the slow progression of degenerative changes. Arthroscopic synovectomy for rheumatoid arthritis of the wrist allows effective pain relief and high patient satisfaction, although any prolonged benefits will require long-term follow-up.

Rheumatoid Synovectomy: Does the Surgical Approach Matter?

“…This procedure may alleviate local pain and swelling [19,26,47,51,56,65] and potentially slow progression of RA [1,5,11,31,35,45,51,52] by removing the synovial lining, the inflammatory target [17]. Whether this procedure can TJA = total joint arthroplasty; NA = not applicable owing to insufficient data; SD = standard deviation.…”

“…Whether this procedure can TJA = total joint arthroplasty; NA = not applicable owing to insufficient data; SD = standard deviation. benefit patients with radiographically advanced RA is unknown [14,20,37,42,50,51]. Whether the arthroscopic versus the open approach to the procedure affects pain relief, recurrence, radiographic progression, or need for subsequent TJA is unknown [65].…”

“…From each study the following data were collected: first author, year of publication, journal, joint involved, approach (open versus arthroscopic), number of subjects, average age of subjects, number of female subjects, length of average followup, percent of patients with pain reduction at last followup, percent of patients with recurrence of synovitis at last followup (as defined by various authors as either erythema, swelling, heat, and/or the need for repeat synovectomy [19,39,51,65]), percent of patients with radiographic progression at last followup (an increase in numeric grade as defined by Larsen et al [34], Steinbrocker et al [63], the modification by Rau and Herborn of the system by Larsen et al [55], Smiley and Wasilewski [60], or Crossan and Vallance [12]), percent of patients who underwent arthroplasty or arthrodesis of the joint in question by last followup, percent of patients with radiographically advanced disease preoperatively defined by Stage III or greater [34] (Table 1), or Stage III or greater according to Steinbrocker et al [63], and whether the study concluded their intervention affected ROM. All studies were reviewed and evaluated by one author (PNC).…”

“…By removing all visible synovial lining, synovectomy can alleviate local pain and swelling [19,26,47,51,56,65]. Additionally, by removing the inflammatory target, synovectomy could slow progression of RA [1,5,11,35,52], although this point is contested [31,45,51]. Advanced RA (radiographically defined as Larsen Stages III-V [34]) traditionally has been viewed as a contraindication to synovectomy, as the procedure does not address changes in the articular cartilage or subchondral bone [42].…”

“…Advanced RA (radiographically defined as Larsen Stages III-V [34]) traditionally has been viewed as a contraindication to synovectomy, as the procedure does not address changes in the articular cartilage or subchondral bone [42]. However, some authors have argued that synovectomy relieves pain even for advanced RA [14,20,37,50,51].…”