The role of arthroscopic synovectomy in patients with undifferentiated chronic monoarthritis of the wrist

Abstract

We investigated the clinical response to arthroscopic synovectomy in patients with undifferentiated chronic monoarthritis (UCMA) of the wrist. Arthroscopic synovectomy was performed on 20 wrists in 20 patients with UCMA of the wrist who had not responded to non-steroidal anti-inflammatory drugs. The mean duration of symptoms at the time of surgery was 4.3 months (3 to 7) and the mean follow-up was 51.8 months (24 to 94). Inflamed synovium was completely removed from the radiocarpal, midcarpal and distal radioulnar joints using more portals than normal. After surgery, nine patients had early remission of synovitis and 11 with uncontrolled synovitis received antirheumatic medication. Overall, there was significant improvement in terms of pain relief, range of movement and Mayo score. Radiological deterioration was seen in five patients who were diagnosed as having rheumatoid arthritis during the follow-up period. Lymphoid follicles and severe lymphocyte infiltration were seen more often in synovial biopsies from patients with uncontrolled synovitis. These results suggest that arthroscopic synovectomy provides pain relief and functional improvement, and allows rapid resolution of synovitis in about half of patients with UCMA of the wrist.

Wrist Arthroscopy in Juvenile Idiopathic Arthritis: A Review of Current Literature and Future Implications

“…They too noted slowed progression in disease, with 14 patients showing no radiological change and 5 patients showing slowed progression of Larsen grade over the 51.8-month follow-up period. 25 Several studies echoed these findings in their patient cohorts. 21,23,26 Kim and Jung recommended AS for pain relief and functional recovery in early RA.…”

“…18,20 In adults with RA, wrist arthroscopy and AS are associated with pain relief, increased ROM, and improvement in general function. 16,17,21,23,25,26 In addition, studies evaluating longterm follow-up found that AS induced sustained remission and slowed radiological progression of disease when antirheumatic medications alone failed to control the inflammation. 16,21,23,25,26 Lee et al noted that AS afforded a significant reduction in pain and controlled synovitis in 75% of adult patients with RA not responding to medication.…”

“…17 Several reviews from different units had similar results, showing reduced levels of pain and improved wrist function following AS for patients resistant to medical management. 16,21,23,25,26…”

Arthroscopic synovectomy of the wrist

“…If synovitis worsens again after it is well controlled with medication initially, then synovectomy should be considered if there is no improvement for 2 to 3 months. In addition, if a change in the joint space is narrowed compared to several months ago on the radiograph, it is judged that the damage to the articular cartilage is progressing quickly and synovectomy should be performed [5,11,14,16,17]. The most important purpose of synovectomy is to preserve articular cartilage.…”

“…It also facilitates effective removal of pathologic synovium. Moreover, it offers minimal scarring and subsequent reduction of postoperative pain [5,[12][13][14].…”