Background In cases refractory to conservative treatment chronic knee synovitis, surgical procedures are recommended. The role of arthroscopic synovectomy in improvement quality of life and knee function is still in discussion.
Objectives To assess the results of arthroscopic synovectomy (AS) and its influence on Quality-of-Life Index (QLI) of the patients with rheumatoid arthritis (RA) in treatment of chronic knee synovitis.
Methods Since 2003 and up till 2011 in the orthopaedic department of Institute of Rheumatology were performed 120 AS of the knee jointfor 105 patients with RA. Average follow-up period-4,1±2,03 years, mean age-41,1±14,4 years. In history of all patients during the treatment with basic anti-inflammatory drugs, oral and intraarticular administration of glucocorticoids (GC), there has been a stable chronic knee synovitis for more than three months.
Patients were evaluated by: EQ-5D questionnaire analysis, HAQ functional assessment, Knee Society Score (KSS) functional check. The effect of AS on pain relief was measured by Visual analogue scale (VAS) for pain before and after the surgery.
Results Analysis of the drug therapy has shown that during the first years of illness 12,5% of the patients received sulfasalazine (2 g daily), however the treatment was not lengthy (1,8±1,6 years). 80,4% of the patients received methotrexate (MT) in small doses (7,5-10 mg weekly) and inconstantly (usually the treatment was stopped by the patients themselves), the duration of its continuous intake was around 2,3±2,5 years. Leflunomide (LF) dose of 20 mg daily was administered in cases of intolerance or inefficiency of MT for 19,2% of the patients. 36,7% received GC orally. In history of 100% of the patients were ineffective intraarticular injections of GC for more than 3 months. Our study showed, that AS successfully alleviated the synovitis symptoms, improved knee function and QLI: HAQ index before surgery was 1,33±0,88, and after 0,75±0,72 (p<0,05). A positive dynamics was also recorded for EQ-5D index:0,39[-0,24-1,0] vs 0,64[0,06-1,0](before and after surgery respectively, p<0,05). VAS for pain: 50,2±26,89 vs 21,7±21,98 (before and after surgery respectively, p<0,05). KSS functionality of the treated knee has improved: 39±18,5 vs 74,1±28,9 (before and after the surgery respectively); as for analyzing the condition of the knee joint the average results were 48,3±18,7 vs 69,1±26,9 (before and after the surgery respectively, p<0,05). Range of motion increased up to the score of 22,8±3,2 (114° ±16 °) in comparison to 20,4±2,3before the surgery (102°±11,5°, p<0,05).
3,3% of the patients had a second AS, 4,2% required total arthroplasty of the knee joint.
Conclusions The results above demonstrate that AS is an effective method of treatment of chronic knee synovitis in cases of RA which can not only improve the knee function but also raise QLI of the patients.
Disclosure of Interest None Declared
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