1
|
Chadwick NS, Weaver JS, Shechtel JL, Hall GL, Shultz CL, Taljanovic MS. Update on elbow arthroplasties with emphasis on imaging. Pol J Radiol 2024; 89:e249-e266. [PMID: 38938657 PMCID: PMC11210383 DOI: 10.5114/pjr/186592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/28/2024] [Indexed: 06/29/2024] Open
Abstract
Elbow arthroplasty is increasing in popularity and can be used to treat many conditions, such as trauma, primary and secondary osteoarthritis, inflammatory arthritis, and osteonecrosis. Total elbow arthroplasty (TEA) is reserved for patients with severe symptoms refractory to more conservative management. In addition to TEA, hemi-arthroplasty, interposition arthroplasty, and resection arthroplasty also play roles in the management of elbow pain. There are specific indications for each type of arthroplasty. Postoperative complications may occur with elbow arthroplasties and may be surgery or hardware related. Imaging is important in both pre-operative planning as well as in post-surgical follow-up. This article reviews the different types of elbow arthroplasties, their indications, their normal postoperative imaging appearances, and imaging findings of potential complications.
Collapse
Affiliation(s)
| | | | | | | | | | - Mihra S. Taljanovic
- University of New Mexico, School of Medicine, United States
- Banner University Medical Center, United States
| |
Collapse
|
2
|
Nossent J, Keen HI, Preen DB, Inderjeeth CA. Joint surgery rates in lupus: a long-term cohort study. Lupus Sci Med 2024; 11:e001045. [PMID: 38199862 PMCID: PMC10806518 DOI: 10.1136/lupus-2023-001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
AIM With scarce data on the need and type of joint surgery in SLE, we investigated the long-term rates and underlying causes for arthroplasty, arthrodesis and synovectomy in patients with SLE. METHODS Procedure dates for arthroplasty, arthrodesis or synovectomy were retrieved from the state-wide Hospital Morbidity Data Collection between 1985 and 2015 for patients with SLE (n=1855) and propensity-matched controls (n=12 840). Patients with SLE with ≥two additional diagnostic codes for rheumatoid arthritis were classified as rhupus. ORs and incidence rates (IRs) per 100 person-years for joint procedures (JPs) were compared among patients with rhupus, patients with other SLE and controls across three study decades by regression analysis. RESULTS More patients with SLE than controls underwent a JP (11.6% vs 1.3%; OR 10.8, CI 8.86 to 13.24) with a higher IR for JP in patients with SLE (1.9 vs 0.1, rate ratio 19.9, CI 16.83 to 23.55). Among patients with SLE, patients with rhupus (n=120, 60.5%) had the highest odds of arthroplasty (OR 4.49, CI 2.87 to 6.92), arthrodesis (OR 6.64, CI 3.28 to 12.97) and synovectomy (OR 9.02,CI 4.32 to 18.23). Over time, the IR for overall JP in patients with rhupus was unchanged (8.7 to 8.6, R2=0.004, p=0.98), although the IR for avascular necrosis underlying arthroplasty decreased for all patients with SLE (0.52 to 0.10, p=0.02). Patients with other SLE also had significantly higher OR and IR for all three JPs than controls with insignificant decreases in synovectomy and increases in arthroplasty over time in this group. CONCLUSIONS The overall burden of joint surgery in SLE is high and despite a reduction in avascular necrosis, arthroplasty and arthrodesis rates have not decreased over time. These data indicate a need for increased efforts to prevent joint damage in patients with lupus.
Collapse
Affiliation(s)
- Johannes Nossent
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Helen Isobel Keen
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David Brian Preen
- School of Population & Global Health, The University of Western Australia Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Charles A Inderjeeth
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Rheumatology and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|
3
|
d'Ailly PN, Deugd C, Schep NWL, Kuijper TM, Kok MR, Willemze A, Coert JH, de Jong PHP, Lam-Tse WK, van der Helm-van Mil AHM, Tchetverikov I, Weel-Koenders AEAM, Bisoendial RJ. Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial). Trials 2023; 24:229. [PMID: 36966310 PMCID: PMC10039772 DOI: 10.1186/s13063-023-07129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/31/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. METHODS This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. DISCUSSION Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. TRIAL REGISTRATION Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. CLINICALTRIALS gov NCT04755127. Registered after the start of inclusion on 15 February 2021.
Collapse
Affiliation(s)
- P N d'Ailly
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - C Deugd
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - T M Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - J H Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W K Lam-Tse
- Department of Rheumatology, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - A E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R J Bisoendial
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Ammitzbøll-Danielsen M, Terslev L. Optimizing the anti-inflammatory strategies in (osteo)arthritis: local or systemic? THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:311-318. [PMID: 35838028 DOI: 10.23736/s1824-4785.22.03477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Arthritis is affecting millions of people globally, involvement and distribution depending on the type of arthritis. The most common arthritic conditions are osteoarthritis (OA) and rheumatoid arthritis (RA). Despite the pathogeneses being fundamentally different, both joint diseases share the same need for local treatment of synovitis. No current treatment can stop the progression of OA. Local articulate treatment including glucocorticoid (GC) injections, radiosynoviorthesis (RSO) and surgical synovectomy are the only options to relieve pain and temporally improve movability before surgical intervention. For RA, despite effective systemic treatments, similarly need for local articulate treatment is still present, especially early in the disease, but also in case of recurrent episodes of disease flare. Current evidence supports local GC injection as first line treatment for persistent synovitis in a single or a few joints. RSO provides an evident and effective alternative for GC refractory synovitis, especially in early RA. Surgical synovectomy is an invasive alternative, but with less documented efficacy. Whether one unsuccessful intraarticular GC injection is enough to change of mode of action for local treatment is still unclear and needs to be further investigated. In conclusion persistent single joint synovitis in OA and RA is well treated with local treatment. Intra-articular GC injection is considered as first line of treatment, but RSO provides an additional treatment alternative with less side effects and better evidence of efficacy than surgical synovectomy.
Collapse
Affiliation(s)
- Mads Ammitzbøll-Danielsen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark -
- Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark -
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark
- Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Shim JW, Chae SH, Kim IS, Park MJ. Clinical course in patients with chronic undifferentiated arthritis of the elbow after arthroscopic synovectomy. J Shoulder Elbow Surg 2022; 31:2514-2520. [PMID: 36007866 DOI: 10.1016/j.jse.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/26/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical treatment can be considered for patients with undifferentiated arthritis (UA) limited to the elbow joint. The purpose of this study was to analyze the clinical outcomes of arthroscopic synovectomy. METHODS Nineteen patients who underwent arthroscopic synovectomy for chronic UA of the elbow between 2006 and 2019 were enrolled in this study. One patient was excluded because of evidence of tuberculosis in the biopsy. Chronic UA of the elbow was defined as (1) localized synovitis diagnosed by magnetic resonance imaging, (2) no specific cause, and (3) no response to conservative treatment for >3 months. We compared baseline characteristics and clinical outcomes between the remission and disease progression groups. RESULTS Postoperatively, synovitis was controlled in 13 patients. In 5 patients, the symptoms disappeared after surgery without any medical treatment. Four patients discontinued disease-modifying antirheumatic drugs. Nine patients were classified as in remission. The disease progression group had a longer symptom duration, elevated rheumatoid markers, and higher Larsen grading. However, the difference was not statistically significant. CONCLUSIONS Arthroscopic synovectomy achieved remission in approximately 47% of patients with chronic UA of the elbow. Although arthroscopic synovectomy did not prevent RA, it can be considered for rapid resolution of synovitis and diagnostic purposes.
Collapse
Affiliation(s)
- Jae Woo Shim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Chae
- Lee's Bon Spine & Joint Hospital, Busan, Republic of Korea
| | - Il Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jong Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Shaunak S, Jabbar Y. Cut and cure: surgical therapy of synovitis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:319-323. [PMID: 36106911 DOI: 10.23736/s1824-4785.22.03472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Surgical management for synovitis has undergone radical change in the last few years with the evolution of DMARDs and advanced Interventional Radiology techniques. Here we present areas where surgical therapy may still be the most effective option, either alone or in conjunction with non-surgical measures.
Collapse
Affiliation(s)
- Shalin Shaunak
- Department of Trauma and Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Yaser Jabbar
- Department of Trauma and Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK -
| |
Collapse
|
7
|
Lobenhoffer P. Offene und arthroskopische Synovialektomie. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
d'Ailly PN, Mulders MAM, Bisoendial RJ, Kuijper TM, Coert JH, Schep NWL. Arthroscopic Synovectomy of the Wrist in Patients With Rheumatoid Arthritis: A Systematic Review of the Current Literature. J Clin Rheumatol 2022; 28:77-83. [PMID: 34897196 DOI: 10.1097/rhu.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) of the wrist can lead to loss of wrist function and progressive joint destruction if inadequately treated. Arthroscopic synovectomy of the wrist may prove a valuable treatment for local inflammation. OBJECTIVE The aim of this study was to perform a systematic review evaluating functional outcomes and pain following arthroscopic synovectomy of the wrist in RA patients. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. MEDLINE, EMBASE, The Cochrane Library, Web of Science, and Google Scholar were searched for studies describing pain or functional outcomes following arthroscopic synovectomy of the wrist in RA patients (CRD42021270846). Risk of bias was assessed using the Methodological Index for Non-Randomized Studies. Data collection included patient characteristics, pain scores, wrist function questionnaires, secondary surgery, and complications. RESULTS Six noncomparative cohort studies were included, with a total of 153 arthroscopic synovectomies. Disease duration of RA ranged from 32 to 89 months, and radiographic progression was mild to moderate. The Methodological Index for Non-Randomized Studies scores ranged from 8 to 10 out of 16. Mean follow-up ranged from 21 to 95 months. Improvements were seen in pooled mean visual analog scale pain score (from 7.7 to 2.2, p < 0.05), pooled mean Modified Mayo Wrist Score (from 43.3 to 70.4, p < 0.05), and the Disability of the Arm, Shoulder, and Hand (from 67.5 to 36.5, p < 0.05). Two complications occurred, and 5 patients required secondary surgery. CONCLUSIONS There is limited evidence suggesting that arthroscopic synovectomy of the wrist improves wrist function and pain in patients with RA, with few complications. In centers with arthroscopic expertise, it can be considered as a treatment option.
Collapse
Affiliation(s)
| | | | - Radjesh J Bisoendial
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam
| | - T Martijn Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam
| | - J Henk Coert
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niels W L Schep
- From the Department of Surgery, Maasstad Hospital, Rotterdam
| |
Collapse
|
9
|
[Therapeutic options in juvenile idiopathic arthritis : Surgical and conservative orthopedic rheumatological treatment]. Z Rheumatol 2021; 80:467-480. [PMID: 33881586 DOI: 10.1007/s00393-021-00996-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
The treatment of juvenile idiopathic arthritis (JIA) has made substantial progress within the last 25 years. Modern medicinal treatment enables inflammatory activity of the disease to be controlled in most of the cases. Mutilating courses of disease, which were formerly the rule have now become the exception. Today remission of disease is the aim of pediatric rheumatological treatment. Apart from effective control of inflammation this includes complete restoration of functional abilities of affected joints and the surrounding structures also affected. To achieve this goal a holistic and foresighted view of each patient's course is required. Therefore, even in an apparently uncomplicated course of disease in some cases of JIA it is advisable to plan an early interdisciplinary consultation including the pediatric rheumatologist and the orthopedic surgeon, in order to discuss an early surgical intervention, which can then be carried out in a timely manner, if necessary. This article provides an overview of the orthopedic rheumatological indications and options.
Collapse
|
10
|
Biomechanical Particularities in the Therapy of the Rheumatic Knee. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In rheumatoid arthritis, the joints of the lower extremities are almost always affected. This is most conspicuous in the knee joint. In rheumatics, inflammatory osteoarthritis manifests itself comparably earlier than in patients with osteoarthritis. The focus of attention was primarily on the synovia with its destruction process and secondary changes. Now, driven by experimental research, dendritic cells and fibroblasts and molecular features are moving into the clinician’s field of vision. Even in joints that appear to be in remission with no swelling or pain, the activity of these cells leads to changes in the capsule-ligaments. The complex deformities and instabilities caused by this, in conjunction with atrophy of the inter-articular musculature, have an impact on the activities of daily life (ADL). If these biomechanical aspects of the knee joint are not taken into account early on in therapy, the frequency of primary and secondary surgical treatment increases. The timely recognition of biomechanical pathologies and consistent treatment can contribute to improving the patient situation in addition to adequate medication therapy.
Collapse
|
11
|
Pulsed Electromagnetic Field Inhibits Synovitis via Enhancing the Efferocytosis of Macrophages. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4307385. [PMID: 32596310 PMCID: PMC7273431 DOI: 10.1155/2020/4307385] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/06/2020] [Indexed: 01/15/2023]
Abstract
Synovitis plays an important role in the pathogenesis of arthritis, which is closely related to the joint swell and pain of patients. The purpose of this study was to investigate the anti-inflammatory effects of pulsed electromagnetic fields (PEMF) on synovitis and its underlying mechanisms. Destabilization of the medial meniscus (DMM) model and air pouch inflammation model were established to induce synovitis in C57BL/6 mice. The mice were then treated by PEMF (pulse waveform, 1.5 mT, 75 Hz, 10% duty cycle). The synovitis scores as well as the levels of IL-1β and TNF-α suggested that PEMF reduced the severity of synovitis in vivo. Moreover, the proportion of neutrophils in the synovial-like layer was decreased, while the proportion of macrophages increased after PEMF treatment. In addition, the phagocytosis of apoptotic neutrophils by macrophages (efferocytosis) was enhanced by PEMF. Furthermore, the data from western blot assay showed that the phosphorylation of P38 was inhibited by PEMF. In conclusion, our current data show that PEMF noninvasively exhibits the anti-inflammatory effect on synovitis via upregulation of the efferocytosis in macrophages, which may be involved in the phosphorylation of P38.
Collapse
|
12
|
Mosquera N, Rodriguez-Trillo A, Blanco FJ, Mera-Varela A, Gonzalez A, Conde C. All-Trans Retinoic Acid Inhibits Migration and Invasiveness of Rheumatoid Fibroblast-Like Synoviocytes. J Pharmacol Exp Ther 2019; 372:185-192. [PMID: 31801802 DOI: 10.1124/jpet.119.261370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022] Open
Abstract
Fibroblast-like synoviocytes (FLSs) are pivotal in inflammation and joint damage of rheumatoid arthritis (RA). They acquire an active and aggressive phenotype, displaying increased migration and invasiveness and contributing to perpetuate synovial inflammation and destruction of cartilage and bone. The main current therapies of RA are focused against inflammatory factors and immune cells; however, a significant percentage of patients do not successfully respond. Combined treatments with drugs that control inflammation and that reverse the pathogenic phenotype of FLS could improve the prognosis of these patients. An unexplored area includes the retinoic acid, the main biologic retinoid, which is a candidate drug for many diseases but has reached clinical use only for a few. Here, we explored the effect of all-trans retinoic acid (ATRA) on the aggressive phenotype of FLS from patients with RA. RA FLSs were treated with ATRA, tumor necrosis factor (TNF), or TNF+ATRA, and cell migration and invasion were analyzed. In addition, a microarray analysis of expression, followed by gene-set analysis and quantitative polymerase chain reaction validation, was performed. We showed that ATRA induced a notable decrease in FLS migration and invasion that was accompanied by complex changes in gene expression. At supraphysiological doses, many of these effects were overridden or reverted by the concomitant presence of TNF. In conclusion, these results have demonstrated the therapeutic potential of retinoic acid on RA FLS provided TNF could be counterbalanced, either with high ATRA doses or with TNF inhibitors. SIGNIFICANCE STATEMENT: All-trans retinoic acid (ATRA) reduced the rheumatoid arthritis (RA) fibroblast-like synoviocyte migration and invasiveness and down-regulated gene expression of cell motility and migration genes. At supraphysiological doses, some of these effects were reverted by tumor necrosis factor. Therefore, ATRA could be an RA drug candidate that would require high doses or combined treatment with anti-inflammatory drugs.
Collapse
Affiliation(s)
- Nerea Mosquera
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (N.M., A.R.-T., A.G., C.C.); Servicio de Reumatología, Instituto de Investigacion Biomedica de A Coruña (INIBIC)-Hospital Universitario A Coruña, A Xubias 84, A Coruña, Spain (F.J.B.); and Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (A.M.-V.)
| | - Angela Rodriguez-Trillo
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (N.M., A.R.-T., A.G., C.C.); Servicio de Reumatología, Instituto de Investigacion Biomedica de A Coruña (INIBIC)-Hospital Universitario A Coruña, A Xubias 84, A Coruña, Spain (F.J.B.); and Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (A.M.-V.)
| | - Francisco J Blanco
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (N.M., A.R.-T., A.G., C.C.); Servicio de Reumatología, Instituto de Investigacion Biomedica de A Coruña (INIBIC)-Hospital Universitario A Coruña, A Xubias 84, A Coruña, Spain (F.J.B.); and Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (A.M.-V.)
| | - Antonio Mera-Varela
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (N.M., A.R.-T., A.G., C.C.); Servicio de Reumatología, Instituto de Investigacion Biomedica de A Coruña (INIBIC)-Hospital Universitario A Coruña, A Xubias 84, A Coruña, Spain (F.J.B.); and Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (A.M.-V.)
| | - Antonio Gonzalez
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (N.M., A.R.-T., A.G., C.C.); Servicio de Reumatología, Instituto de Investigacion Biomedica de A Coruña (INIBIC)-Hospital Universitario A Coruña, A Xubias 84, A Coruña, Spain (F.J.B.); and Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (A.M.-V.)
| | - Carmen Conde
- Laboratorio de Reumatología Experimental y Observacional, y Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (N.M., A.R.-T., A.G., C.C.); Servicio de Reumatología, Instituto de Investigacion Biomedica de A Coruña (INIBIC)-Hospital Universitario A Coruña, A Xubias 84, A Coruña, Spain (F.J.B.); and Servicio de Reumatología, Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saude (SERGAS), Travesía da Choupana s/n, Santiago de Compostela, Spain (A.M.-V.)
| |
Collapse
|
13
|
Arbogast M, Haas JP. [Treatment options in juvenile idiopathic arthritis : Part 2: Orthopedics und surgery]. DER ORTHOPADE 2018; 47:919-927. [PMID: 30291371 DOI: 10.1007/s00132-018-3644-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In most cases of juvenile idiopathic arthritis (JIA), disease remission can be achieved by a multidisciplinary approach using modern medication. However, JIA is currently incurable An interdisciplinary concept is therefore needed for long-term development of affected joints and tendons. Only early interdisciplinary treatment strategies can improve long-term outcomes in patients with a complicated disease course or persistent disease activity, thereby delaying or even avoiding joint replacement. An early interdisciplinary assessment and treatment planning according to surgical orthopedic rheumatology aspects is now state of the art and will continue to be in the future, especially in treatment-refractory disease courses.
Collapse
Affiliation(s)
- M Arbogast
- Abteilung für Rheumaorthopädie und Handchirurgie, Zentrum für Rheumatologie, Orthopädie und Schmerztherapie, Klinik Oberammergau, Hubertusstraße 40, 82487, Oberammergau, Deutschland.
| | - J-P Haas
- Kinderklinik Garmisch-Partenkirchen gGmbH, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen, Deutschland
| |
Collapse
|
14
|
Abstract
The knee joint is often involved in rheumatoid arthritis. Despite ever-improving medical antirheumatic therapies, surgical treatment continues to play an important role in optimal multidisciplinary care. The aim of the present work is to process current orthopedic surgical therapy procedures on the knee joint according to disease stage. In the early phase, joint-preserving arthroscopic procedures for synovectomy are used. In advanced joint destruction, joint function can be restored by total knee arthroplasty. Of central importance for optimal patient care are individual treatment and good interdisciplinary coordination of all involved specialist groups.
Collapse
|
15
|
Liu WX, Jiang Y, Hu QX, You XB. Improved quality of life and joint functions in patients with knee rheumatoid arthritis who underwent five portal arthroscopic synovectomy. PeerJ 2018; 6:e4727. [PMID: 29736348 PMCID: PMC5933344 DOI: 10.7717/peerj.4727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/17/2018] [Indexed: 12/29/2022] Open
Abstract
Objectives To evaluate the outcomes of patients with rheumatoid arthritis (RA) of the knee who underwent five portal arthroscopic synovectomy, with or without post-operative negative pressure drainage (NPD). Material and Methods A prospective clinical trial was performed. Patients with class I, II, and III RA of the knee were enrolled. They underwent five portal arthroscopic synovectomy. Post-operatively, they received either NPD (group A) or non-NPD (group B). Health assessment questionnaire (HAQ), disease activity score 28 (DAS 28), and Lysholm knee joint score were evaluated before the operations, and at six weeks, three months, and one year after the operations. Results A total of 36 patients were enrolled into the study, with 63.9% (23) female patients and mean age of 47.2 years old. All of the patients had clinical symptoms (joint swelling, pain, and dysfunction) for at least six months with poor responses to the traditional pharmaceutical therapy. There were 12, 16, and eight patients in class I, II, and III RA groups, respectively (six IA, six IB, eight IIA, eight IIB, four IIIA, and four IIIB). One year after the operation, patients had statistically significant improvements on HAQ, DAS 28, and Lysholm knee joint scores. More improvements were observed in patients with class I diseases. There were no statistically significant differences between group A and B. Conclusion Five portal arthroscopic synovectomy could increase the quality of life, decrease disease activities, and improve joint functions in patients with RA. More benefits were observed in patients with early disease developments. Patients in the NPD group did not show more improvements compared to the patients in the non-NPD group.
Collapse
Affiliation(s)
- Wen-Xin Liu
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yao Jiang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Qing-Xiang Hu
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xie-Bo You
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| |
Collapse
|
16
|
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist.
Collapse
|
17
|
Giant Baker's Cyst Associated with Rheumatoid Arthritis. Case Rep Orthop 2017; 2017:4293104. [PMID: 28116197 PMCID: PMC5237725 DOI: 10.1155/2017/4293104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/10/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of a "giant Baker's cyst-related rheumatoid arthritis (RA)" with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker's cyst-related RA, which was treated as described, has not yet been presented.
Collapse
|
18
|
Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by the 2010 ACR/EULAR criteria. Knee 2016; 23:862-6. [PMID: 27318499 DOI: 10.1016/j.knee.2016.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 05/07/2016] [Accepted: 05/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aims of this study were: (1) to evaluate the mid-term results and survivorship of arthroscopic synovectomy (AS) of the knee in rheumatoid arthritis (RA) defined with the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria; and (2) to identify prognostic factors. METHODS Patients matching the 2010 ACR/EULAR criteria, with symptomatic knee synovitis for at least six months, treated with arthroscopic synovectomy of the knee at a minimum of three year followup were included. Pre-operative evaluation included Larsen, HAQ, DAS28, and Laurin scores. Post-operatively, Laurin, WOMAC, and patient satisfaction scores were evaluated. Different variables were investigated to find associations with the outcomes. Kaplan-Meier survival analysis was performed. RESULTS Sixty-four patients met the inclusion criteria. Seven patients (9.6%) were lost to followup, leaving 57 patients (66 knees) for the present study. The average followup was 96.3months (SD 41). The pre-operative Laurin score was 3.91 points (SD 1.3) and significantly (P<0.001) improved after surgery (mean 8.2, SD 2). The post-operative average WOMAC score was 73.9 points (SD 45.9). Eighteen knees (27.3%) underwent revision procedures at an average of 48.6 months (SD 39.8). Joint degeneration (Larsen grade III) and range of movement (ROM) reduction (>10%) were identified as negative prognostic factors. Kaplan-Meier survivorship with total knee replacement as endpoint was: 78% at one year, 28% at four years, and six percent at 10 years. CONCLUSIONS Although AS of the knee has still a role as a salvage procedure in the treatment of RA synovitis with initial joint degeneration (less than Larsen grade III) and good ROM, high revision rates and limited survivorship are reported.
Collapse
|
19
|
Update on the surgical treatment for rheumatoid arthritis of the wrist and hand. J Hand Ther 2014; 27:134-41; quiz 142. [PMID: 24530143 DOI: 10.1016/j.jht.2013.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/29/2013] [Accepted: 12/01/2013] [Indexed: 02/03/2023]
Abstract
Surgical procedures for the treatment of rheumatoid arthritis are aimed at restoring function and decreasing pain. Over the past four decades multiple procedures have been described in the management of early and late disease. This article will review the most common forms of surgery used in the treatment of rheumatoid arthritis.
Collapse
|
20
|
Luczkiewicz P, Kokotkiewicz A, Dampc A, Luczkiewicz M. Mangiferin: A promising therapeutic agent for rheumatoid arthritis treatment. Med Hypotheses 2014; 83:570-4. [DOI: 10.1016/j.mehy.2014.08.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
|
21
|
Watanabe N, Iguchi H, Mitsui H, Tawada K, Murakami S, Otsuka T. Hip Arthroscopic Synovectomy and Labral Repair in a Patient With Rheumatoid Arthritis With a 2-Year Follow-up. Arthrosc Tech 2014; 3:e523-6. [PMID: 25276611 PMCID: PMC4175552 DOI: 10.1016/j.eats.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 06/03/2014] [Indexed: 02/03/2023] Open
Abstract
The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs.
Collapse
Affiliation(s)
- Nobuyuki Watanabe
- Department of Orthopedics, Tosei General Hospital, Seto, Japan
- Address correspondence to Nobuyuki Watanabe, M.D., Ph.D., Department of Orthopedics, Tosei General Hospital, Nishioiwake 160, Seto, Aichi Prefecture 489-0065, Japan.
| | - Hirotaka Iguchi
- Department of Arthroplastic Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Hiroto Mitsui
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Kaneaki Tawada
- Department of Orthopedics, Komaki Municipal Hospital, Komaki, Japan
| | - Satona Murakami
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| |
Collapse
|
22
|
Long-term results of arthroscopic wrist synovectomy in rheumatoid arthritis. J Hand Surg Am 2014; 39:1295-300. [PMID: 24861384 DOI: 10.1016/j.jhsa.2014.04.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of arthroscopic wrist synovectomy on the clinical course of rheumatoid arthritis in a large series with long-term follow-up. METHODS We performed arthroscopic synovectomy on 56 wrists in 49 patients with rheumatoid arthritis. At a mean follow-up of 7.9 years (range, 5-12 y), we evaluated pain and patient satisfaction using a visual analog scale and assessed overall function using the Mayo wrist score. Radiographic stage was graded according to Larsen stage. We determined clinical outcomes on the recurrence of wrist synovitis, which we evaluated by symptoms of pain and swelling and physical examination. Preoperative variables were statistically analyzed to find factors that could influence the results. RESULTS The mean visual analog scale score for wrist pain decreased from 6.3 to 1.7, and the mean Mayo wrist score (evaluated in 39 wrists) improved from 48 (range, 5-70) to 76 (range, 55-100). The mean visual analog scale score for patient satisfaction was 7.9. At final follow-up, synovitis was controlled in 42 wrists (75%) and recurred in the others. The mean Larsen stage progressed from 2.2 to 3.3. Analysis of preoperative variables revealed no factors that significantly affected clinical outcomes in terms of sex, age, duration of wrist symptom, preoperative serologic inflammatory markers, or Larsen stage. CONCLUSIONS Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
|
23
|
Papatheodorou LK, Baratz ME, Sotereanos DG. Elbow arthritis: current concepts. J Hand Surg Am 2013; 38:605-13. [PMID: 23391361 DOI: 10.1016/j.jhsa.2012.12.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/27/2012] [Indexed: 02/02/2023]
Abstract
Elbow arthritis is a debilitating condition manifesting as a painful, stiff elbow. The purpose of this article is to provide an update and analyze current management, treatment options, and outcomes of treatment for elbow arthritis. This article focuses on recent developments in the treatment for elbow arthritis. Nonsurgical management may provide symptomatic relief in the majority of patients in the early stages of the disease process. Surgical treatment is guided by disease etiology and severity, patient age, and functional demands. Arthroscopic or open synovectomy, debridement arthroplasty, and interposition arthroplasty are generally recommended for the young and active patient population, whereas for low-demand and elderly patients with end-stage painful arthritis, total elbow arthroplasty is considered a more suitable surgical option. Advances in arthroscopic techniques and implant design have led to substantial improvements in the treatment of elbow arthritis.
Collapse
Affiliation(s)
- Loukia K Papatheodorou
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Orthopaedic Specialists-UPMC, Pittsburgh, PA 15237, USA
| | | | | |
Collapse
|
24
|
Choi WJ, Choi GW, Lee JW. Arthroscopic synovectomy of the ankle in rheumatoid arthritis. Arthroscopy 2013; 29:133-40. [PMID: 23142296 DOI: 10.1016/j.arthro.2012.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/16/2012] [Accepted: 06/19/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcome of arthroscopic synovectomy of the ankle joint in patients with early-stage rheumatoid arthritis (RA). METHODS Between 2005 and 2009, 18 consecutive patients with RA involving the ankle underwent arthroscopic synovectomy. Pain was measured using a visual analog scale (VAS), and clinical outcome was determined by calculating the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score with a mean follow-up of 5 years (60 months). Assessments were performed preoperatively, at 6 and 12 months postoperatively, and then yearly thereafter. Clinical success was defined as the absence of synovitis symptoms or when patients demonstrated good or excellent outcomes (AOFAS Ankle-Hindfoot Scale score ≥80) with >50% improvement in VAS score for pain. Demographic, laboratory, and radiological variables were evaluated to determine possible factors predicting clinical outcome. RESULTS VAS and AOFAS scores were significantly improved at the final follow-up (60 months; P < .0001). The greatest improvements in clinical scores were observed after 12 months; thereafter, they steadily declined. Of the 18 patients examined, 14 (77.8%) were considered to have had clinical success with no reintervention. Variables predictive of clinical success were short duration of symptoms (P = .042) and minimal radiographic changes based on the Larsen grading system (P = .030). CONCLUSIONS Arthroscopic synovectomy is a safe and successful procedure in ankle joints affected by RA. The best clinical outcomes are achieved when the procedure is performed early in the disease course and when there is no evidence of cartilage degeneration. LEVEL OF EVIDENCE Level IV, prognostic case series.
Collapse
Affiliation(s)
- Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | | | | |
Collapse
|
25
|
Oztemür Z, Bulut O, Korkmaz M, Gölge UH, Oztürk H, Tezeren G, Günaydın I. Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis. Rheumatol Int 2012; 33:1321-6. [PMID: 23132540 DOI: 10.1007/s00296-012-2540-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 10/21/2012] [Indexed: 11/30/2022]
Abstract
Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.
Collapse
Affiliation(s)
- Zekeriya Oztemür
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey.
| | | | | | | | | | | | | |
Collapse
|
26
|
Management of persistent inflammatory large joint monoarthritis. Clin Rheumatol 2012; 31:1657-62. [DOI: 10.1007/s10067-012-2104-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/17/2012] [Indexed: 01/01/2023]
|