Objectives to evaluate effectiveness, the clinical outcomes and quality of life before and after arthroscopic synovectomy in patients with rheumatoid arthritis
Methods Arthroscopic synovectomy of elbow was performed on in 21 patients with RA with radiographic changes of Larsen grade 3 or less. All patients had severe pain and swelling, resulting from acute or chronic synovitis, that had not responded to conservative treatment during 6 months. We performed total synovectomy of the elbow using multiple portals. Pain was evaluated with a visual analog scale and range of motion was measured. The Mayo Elbow Performance Score and Oxford Elbow Score was used to assess total elbow function; EQ-5D, HAQ – for evaluation quality of life
Results The average age of patients was 40,5±13,25 years (18 to 57 years) and there was a 11 female and 10 male (1,1:1). There were 50% seropositive patients. The mean of follow up was 12.5±5,2 months (ranging from 7 to 22). The average duration of RA was 7,87±6,37 years. The average duration elbow complains 2,25±1,62 years. There were pain in 100% patients, synovitis and contrarture of elbow joint.
The average increase in flexion was from 114,4° preoperatively to 127,5° at long term follow up and extension was from 27,5° preoperatively to 2,3° (p< 0.05). The average increase in Mayo Elbow Score 48,75/93,12 and Oxford Elbow Score 18,5/8,87 on long term follow up (p < 0.05). The mean EQ-5D (index) score improved from 0.23 to 0.72, HAQ from 1,59 to 0,84; VAS from 61,25 to 8,75. There was no neurovascular complication and infection, but in 6 cases (28,57%) were recurrent synovitis
Conclusions Arthroscopic synovectomy of the elbow effectively relieve pain, increase range of motion and quality of life, improve Mayo and Oxford Elbow Score, although recurrent synovitis occurs in some patients
References rheumatoid arthritis, arthroscopic synovectomy, elbow
Disclosure of Interest None Declared