title: Arthroscopic synovectomy for rheumatoid wrists and elbows.
abstract: OBJECTIVE
  To evaluate the treatment outcome of wrist and elbow arthroscopic synovectomy for patients with rheumatoid arthritis.
  
  
  METHODS
  3 men and 18 women aged 27 to 71 (mean, 54) years underwent arthroscopic synovectomy for rheumatoid arthritis of the wrist (n=12) and elbow (n=13). All patients had received multiple medications including non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and steroids, as well as physiotherapy and splintage for 6 months, but the joint pain and disability persisted. The median duration of rheumatoid arthritis was 89 (range, 24-156) and 108 (range, 36-360) months for the wrist and elbow joints, respectively. According to the Larsen grading, the radiographic stages of the wrists and elbows were classified as grade 1 (n=4+4), grade 2 (n=4+5), and grade 3 (n=4+4). Visual analogue scale for pain, the wrist and elbow flexion-extension arcs, grip strength, key pinch strength, inflammatory markers, disability and symptoms were compared pre- and post-operatively.
  
  
  RESULTS
  The median follow-up period was 30 (range, 18-78) and 34 (range, 18-78) months for wrists and elbows, respectively. There was significant improvement in pain, joint motion, inflammatory markers, and disability score. All patients were satisfied with the surgery. There was no neurovascular or wound complication. No patient was taking longterm pain-control drugs. One patient underwent a second arthroscopic synovectomy after 15 months owing to exacerbation of arthritis.
  
  
  CONCLUSIONS
  Arthroscopic synovectomy is recommended for patients with rheumatoid arthritis who fail conservative treatment.
authors.affiliation: Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Hong Kong. chungstephen@gmail.com
authors.forename: Chor-yat Stephen
authors.initials: CY
authors.lastname: Chung
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Yen
authors.forename: Man-Lung Ronald
authors.initials: ML
authors.lastname: Yip
authors.forename: Siu-Cheong Jeffrey Justin
authors.initials: SC
authors.lastname: Koo
authors.forename: Weng-Nga Virginia
authors.initials: WN
authors.lastname: Lao
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001182:Arthroscopy; D004551:Elbow Joint; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000074402:Synovectomy; D014955:Wrist Joint