Arthroscopic synovectomy in rheumatoid synovitis of knee joint

Objective. To determine indications to and efficacy of arthroscopic synovectomy (AS) via anteriolateral portal in rheumatoid arthritis (RA) with knee joint synovitis. Material and methods. 139 pts with RA and knee joint synovitis were included. Kneeswelling, pain, restriction of movement score (from 0 to 3) were assessed at baseline and at the end of the study. Coefficient of conservative treatment inefficacy (duration of treatmentwithout significant improvement) was counted. Value of this coefficient multiplication by the sum of the above mentioned measures was used to determine indications to AS. AS was indicated in 111 cases (79,9%). It was performed in 72 pts (group 1). In 39 pts of group 2 this operation was not performed. 28 pts without indications to AS (group3) continued conservative treatment. Before the operation and after 6 months pts filled SF-36 questionnaire to assess quality of life. We used Russian version of SF-36 which was prepared to assess quality of life of Saint Petersburg adult inhabitants. This version possesses necessary psychometric features and is appropriate for conducting studies of quality of life and health status of Russian population. Results. AS provided significant improvement. All Clinical measures in group 1 showed similar mean improvement approximately by 1 (from 0,83 to 0,95, p<0,001). Integral measures (physical health and psychological health) in group 1 pts were higher (by 3,4 and 3,8 respectively). In group 3 all clinical measures values decreased to 0-1 while 30,8-48,7% assessments in group 2 pts showed 2 and in 5,1% - 3 for restriction of movement. Conservative treatment in rheumatoid synovitis is not equally effective for all pts. It does not provide sufficient effect in presence of indications to synovectomy. On the other hand in pts with less severe form of the disease not having indications to synovectomy such therapy provides fast and significant clinical improvement during 6 months of follow up. Conclusion. In pts with rheumatoid synovitis of knee joint having indications to this operation AS provides better results than conservative treatment only.

ревматоидный артрит, коленный сустав, синовит, артроско- пическая синовэктомия, оценка качества жизни

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