Comparison of efficacy of arthroscopic lavage plus administration of corticosteroids, arthroscopic lavage plus administration of placebo, and joint aspiration plus administration of corticosteroids in arthritis of the knee: A randomized controlled trial

Abstract

Objective. To compare the efficacy of arthroscopic lavage plus administration of corticosteroids (ALC), arthroscopic lavage plus administration of placebo (ALP), and joint aspiration plus administration of corticosteroids (JAC) in knee arthritis, and to evaluate whether clinical or histologic characteristics determine outcome. Methods. Patients with knee arthritis (not due to gout, osteoarthritis, or septic arthritis) were randomized over 3 treatment arms: ALC, ALP, and JAC. The primary end point was event-free survival, with events defined as 1) recurrence or persistence of symptomatic knee swelling necessitating local re-treatment, or 2) nonimprovement of the knee joint score. Synovial tissue specimens were collected and analyzed histologically to identify predictive factors of responsiveness. Results. A total of 78 patients were enrolled; 3 patients did not receive their allocated therapy and 3 were lost to followup. The median time until recurrence was 9.6 months after ALC, 3.0 months after JAC, and 1.0 month after ALP, corresponding to a relative risk (RR) of arthritis recurrence of 2.2 for JAC (95% confidence interval [95% CI] 1.2-4.2, P ‫؍‬ 0.02) and 4.7 for ALP (95% CI 2.3-9.4, P < 0.0001) compared with ALC. A high versus low synovial extent of fibrosis conferred an RR for recurrence of 5.7 (95% CI 1.6 -20.5, P < 0.01) after ALC. Conclusion. Arthroscopic lavage plus administration of corticosteroids was more effective than arthroscopic lavage plus administration of placebo or joint aspiration plus injection of corticosteroids. The absence of fibrosis was a histologic predictor of a beneficial response.

A Comparative Study between Use of Arthroscopic Lavage and Arthrocentesis of Temporomandibular Joint Based on Computational Fluid Dynamics Analysis

“…The lower velocity in the arthrocentesis group may potentially lead to ineffective removal of the catabolites generated from the inflammatory process. A slightly higher IAP value of 15.532 ± 4.951 kPa was obtained in the KK group (arthroscopic group), thus improving the lysis effect of adhesive fibrous tissue [5,26]. These may explain why the therapeutic effect of the arthroscopy is better than that of arthrocentesis, as shown in previous studies as well as our retrospective study.…”

“…Subsequently it was thought that visualization of the joint is not necessary to accomplish the treatment objectives; thus, arthrocentesis alone can be used as a modification of TMJ arthroscopic lavage in treatment of this condition [3,4]. The therapeutic effect of joint lavage is attributed to removal of inflammatory cells, cytokines, and degradation products of the inflamed synovium, facilitating the anti-inflammatory effects of intra-articular corticosteroid administration [5]. It appears to be a safe and effective method for reducing pain and increasing mandibular range of motion in approximately 86% of patients [6].…”

Residual inflammation after rituximab treatment is associated with sustained synovial plasma cell infiltration and enhanced B cell repopulation

“…Arthroscopy of clinically affected knees was performed at baseline in all patients as previously described14 and the procedure was repeated at 12 weeks after the first infusion of rituximab. Repeat biopsies at 3 months were obtained from the same knee, unless it had been previously injected with prednisolone in which case the contralateral knee was taken.…”

Differences in synovial tissue infiltrates between anti–cyclic citrullinated peptide–positive rheumatoid arthritis and anti–cyclic citrullinated peptide–negative rheumatoid arthritis

“…This score was divided into 2 categories depending on the absence of OA (K/L grades 0 and 1) or the presence of OA (K/L grades 2–4). Before arthroscopy, a Disease Activity Score in 28 joints (DAS28) (8) and a knee score (9) were obtained by a trained research nurse. The knee score (range 0–7) encompassed knee tenderness (range 0–3, where 0 = no tenderness, 1 = tenderness when asked for, 2 = tenderness on pressure, and 3 = tenderness and wincing), knee swelling (range 0–3, where 0 = no swelling, 1 = little swelling, 2 = moderate swelling, and 3 = abundant swelling), and patient‐assessed knee pain on a 100‐point visual analog scale (VAS), where 0 = no pain and 100 = maximal pain.…”