Outcome of radical multiple synovectomy as a novel surgical treatment for refractory rheumatoid arthritis: implication of HLA-DRB1*0405 in post-operative results.
OBJECTIVE
The authors developed a technique for radical multiple synovectomy (RaMS), a novel surgical treatment for refractory rheumatoid arthritis (RA) intended to control RA activity as much as possible. The purpose of this article is to describe the technique and its short-term results.


METHODS
Eighteen RA patients were followed up for at least 3 years after RaMS. Post-operative results were determined and the significance of the HLA-DRB1 alleles was studied.


RESULTS
Six patients met the ARA criteria for clinical remission persistently and were classified as "remission" cases. Thirteen patients in whom the limited Lansbury index remained improved were rated as "improvement". The cumulative success rates for "remission" and "improvement" were 33.3% and 57.8%, respectively, at the time point of the latest observation. Remission was not achieved in any of the DRB1*0405-positive patients. Nine out of 10 DRB1*0405-negative patients showed persistent improvement.


CONCLUSIONS
RaMs provided good results in one-third of patients with refractory RA at a minimum of 3 years. HLA-DRB1*0405 may be a good marker to follow the effects of RaMS in RA patients.
Nakamura
H
H
Department of Joint Disease and Rheumatism, Nippon Medical School, Tokyo, Japan.
Yoshino
S
S
Ishiuchi
N
N
Fujimori
J
J
Kanai
T
T
Nishimura
Y
Y
D000328:Adult; D000368:Aged; D000483:Alleles; D001172:Arthritis, Rheumatoid / Q000235:genetics / Q000276:immunology* / Q000601:surgery*; D005260:Female; D005838:Genotype; D006684:HLA-DR Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006801:Humans; D008297:Male; D008875:Middle Aged; D000074402:Synovectomy; D016896:Treatment Outcome
D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains