The anti-rheumatic effect of multiple synovectomy in patients with refractory rheumatoid arthritis.
We assessed the anti-rheumatic effects of radical multiple synovectomy (RaMS) in patients with rheumatoid arthritis (RA) who did not respond to intensive medical treatment. The selection of patients into three groups, A, B or C, was randomised. Patients assigned to group A (n = 28) continued the prescribed pre-operative medication and had RaMS. Patients assigned to group B (n = 20) were started on a combination therapy with disease-modifying anti-rheumatic drugs (DMARDs) after radical multiple synovectomy. Nineteen RA patients who were started on the same combination therapy as group B but who did not undergo surgery served as controls (group C). The clinical and radiographic findings were assessed for at least 3 years after surgery. Patients in the surgically treated groups (groups A and B) showed a significant reduction in the number of swollen and painful joints and in their ESR and serum CRP levels, and this effect was maintained for at least 3 years. More than 40% of the patients remained in clinical remission during the observation period. The surgical outcome seemed to be superior to that of the controls and did not differ between group A and group B. Articular destruction (assessed by the carpal height ratio) did not progress in the patients who were in clinical remission.
Nakamura
H
H
Department of Joint Disease and Rheumatism, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Nagashima
M
M
Ishigami
S
S
Wauke
K
K
Yoshino
S
S
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D006801:Humans; D000074402:Synovectomy; D017211:Treatment Failure
D018501:Antirheumatic Agents; D002097:C-Reactive Protein