Arthroscopic synovectomy (ASS) of a rheumatoid knee is performed in cases of intractable synovitis. This spares the articular cartilage, and is an effective and simple treatment for chronic knee synovitis. This retrospective study was performed to evaluate the outcome of surgical arthroscopy, and study the clinical results in detail. A total of 160 knees, in 138 patients, were assessed after a mean follow-up of 35 months. There was a statistically significant improvement in pain, synovitis, and walking ability for at least 24 months after surgery. Based on the results of our study, age, duration of rheumatoid arthritis (RA), and erythrocyte sedimentation rate (ESR) and level of C-reactive protein (CRP) at surgery were not predictors of a poor long-term outcome of ASS. However, the clinical results correlated with the Lansbury index, loss of extension of the knee joint, a modified Larsen score, and the Larsen grade of the knee joint. Of the cases studied, total knee arthroplasty (TKA) was performed in 29 knee joints. We concluded that although ASS can reduce local inflammation and delay the need for definitive replacement surgery, patients over 60 years of age who show severe radiographic changes should undergo primary TKA.
We report the unique occurrence and treatment of spontaneous multiple insufficiency fractures after sepsis in a patient with rheumatoid arthritis (RA). The patient was a 53-year-old woman with a 13-year history of RA. Her disease activity was not influenced by a disease-modifying antirheumatic drug (DMARD) regimen that included bucillamine, D-penicillamine, gold, sulfasalazine, and methotrexate. Due to an increased disease activity, her DMARD treatment regimen was changed to leflunomide. She had also undergone corticosteroid therapy with prednisolone ranging from 10 to 15 mg daily over the previous 8 years. She first presented with a wound infection at the surgical site of resection arthroplasty on her left foot, which had caused hematogenous dissemination that led to pelvic abscess and sepsis. For the next 2 years, she experienced multiple insufficiency fractures in parts of the ilium, sacral body, sacral ala, three thoraco-lumbar vertebral bodies (T12, L1, and L2), and subcapital femoral neck without low energy trauma. Postmenopausal osteoporosis, pelvic abscess, sepsis, decreasing daily activity, high RA disease activity, and high-load corticosteroid therapy were considered to be the causes of these fractures. Nonspecific symptoms such as low back pain and fever delayed diagnosis, which may have led to secondary fractures. Although her course after treatment was satisfactory during the study period, we recommend taking repetitive radiographs to detect insufficiency fracture for RA patients with continuing pain and reducing the corticosteroid dose to prevent infection and fracture.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.