Analysis of clinical factors related to the efficacy of shoulder arthroscopic synovectomy plus capsular release in patients with rheumatoid arthritis

Abstract

Shoulder synovectomy is a well-known surgical treatment for rheumatoid arthritis. However, synovectomy alone is insufficient for improving range of motion clinically. We investigated the clinical factors related to the efficacy of shoulder synovectomy performed with capsular release in patients with rheumatoid arthritis. Fifty-four shoulders of 54 patients (12 males, 42 females; mean age 53.3 years) with rheumatoid arthritis were treated by synovectomy plus capsular release. The patients had a mean disease duration of 8.33 years, a mean follow-up period of 5.02 years, and 66.7% received biological treatment. The disease activity score 28 using C-reactive protein, range of motion of the shoulder, and Japanese Orthopaedic Association (JOA) score assessment were used to investigate clinical factors, analyzed by multiple regression analysis, associated with improved outcome. The average disease activity score 28 using C-reactive protein and JOA score improved significantly from 4.29 and 36.7 to 3.11 and 84.6, respectively, with the restoration of range of motion. Multiple regression analysis showed that disease duration and prednisolone were significantly associated with flexion degree and JOA score. Larsen grade and JOA score were not correlated significantly. There was no significant difference in the JOA score between the groups with or without biological medicinal treatment. Shoulder arthroscopic synovectomy performed with capsular release with or without biological treatment effectively improved function. Short disease duration and low prednisolone dose in rheumatoid arthritis were important for prediction of efficacy.

The Rheumatoid Shoulder: Current Surgical Treatments

“…In RA, synovium produces chemokines and cytokines, which are responsible for pain and swelling of the joint and later for the articular destruction [41]. Synovectomy is a treatment method aimed for pain relief and treatment of joint swelling before bony erosions occur [42].…”

“…Although the clinical results are not significantly different between open and arthroscopic synovectomy, due to the immunosuppression resulted by medical treatments and disease itself, arthroscopic approach is mostly preferred. Also short hospital stay and lower risk of shoulder motion restriction are the additional advantages of arthroscopic approach [42]. The results of this treatment method for rheumatoid shoulder are widely discussed in the literature [42][43][44][45][46].…”

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

“…27,28) Most studies report that in RA patients, synovectomy has been shown to be associated with excellent pain relief but not with the prevention of disease progression. Moreover, the outcome is less favorable with synovectomy than with arthroplasty in patients with advanced destruction of the articular cartilage.…”

Surgical synovectomy for rheumatoid arthritis: a comprehensive literature review

“…Furthermore, under the stimulation of the invading inflammatory cells, the synovial cells may also produce proteinases that can break down the extracellular matrix of the cartilage producing fragments which can cause more inflammation. 7,8 Synovectomy refers to the destruction or the surgical removal of the synovium that lines a joint. It is one of the earliest surgical methods introduced to alleviate pain and reduce swelling in patients with severe RA.…”