Arch Hand Microsurg.  2020 Mar;25(1):2-7. 10.12790/ahm.19.0041.

The Adequacy of Evaluation by Rheumatologists before Undergoing Arthroscopic Synovectomy in Rheumatoid Arthritis Patients

• Jeon N
• Kim HJ
• Park MJ

• KMID: 2501100
• DOI: http://doi.org/10.12790/ahm.19.0041

Abstract

Purpose
The purpose of this study was to evaluate the relationship between the progression of arthritis and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) through the treatment-resistant mono joint rheumatoid arthritis treated with arthroscopic synovectomy.
Methods
We retrospectively reviewed 65 patients who underwent arthroscopic synovectomy for rheumatoid wrist or elbow which had not responded to systemic treatment for at least 6 months. The main treatment response evaluation methods of rheumatologists were the American College of Rheumatology (ACR) response criteria, and the ACR/EULAR (European League Against Rheumatism) remission criteria. The medical records, results of laboratory tests and radiographs of wrist or elbow that had been performed by rheumatologists before arthroscopic synovectomy were investigated. We examined whether the results of laboratory tests and arthritic change of radiograph had statistically significant correlation.
Results
The mean duration of joint symptom until referral to orthopedic department was 23 months (range, 1 month to 9.2 years). During this period, rheumatologists had took average one X-ray (range, 0–3). Forty-seven patients (72.3%) had CRP of 1 mg/dL or less as included in the ACR/EULAR remission criteria. Seventeen out of 65 patients who had two or more X-ray were able to evaluate the progression of arthritis. The change of arthritis and mean ESR (p=0.787) or CRP (p=0.303) the same period didn’t have statistically significant relationship (Spearman correlation analysis).
Conclusion
Since the method of evaluating the treatment response of rheumatologists is to assess the systemic condition, arthritis of one joint that is resistant to treatment is considered to require periodic radiographs as method to assess itself.

Keyword

Recalcitrant rheumatoid arthritis; Pauci-joint rheumatoid arthritis; Recalcitrant one joint rheumatoid arthritis

Figure

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  Fig. 1. The wrist X-ray of a 19-year-old female patient who diagnosed with rheumatoid arthritis. (A) The X-ray at the time of diagnosis was looked as nearly normal. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were 36 mm/hr and 0.76 mg/dL, respectively (normal value: ESR, 27 mm/hr; CPR, 0.03 mg/dL). Her ESR/CRP was normalized 4 months after systemic treatment. (B) After 15 months, the X-ray was seen as Larsen stage 3. ESR and CRP were 20 mm/hr and 0.04 mg/dL, respectively. She was regularly treated by rheumatologist.

Reference

References

1. Canale ST, Beaty JH. Campbell's operative orthopaedics. New York, NY: Elsevier/Mosby;2013.

2. Morrey BF. The elbow and its disorders. New York, NY: Saunders/Elsevier;2009.

3. Scott WN. Insall & Scott surgery of the knee. New York, NY: Elsevier;2006.

4. Park MJ, Ahn JH, Kang JS. Arthroscopic synovectomy of the wrist in rheumatoid arthritis. J Bone Joint Surg Br. 2003; 85:1011–5.

5. Kang HJ, Park MJ, Ahn JH, Lee SH. Arthroscopic synovectomy for the rheumatoid elbow. Arthroscopy. 2010; 26:1195–202.

6. Lee HI, Lee KH, Koh KH, Park MJ. Long-term results of arthroscopic wrist synovectomy in rheumatoid arthritis. J Hand Surg Am. 2014; 39:1295–300.

7. Lipina M, Makarov M, Mukhanov V, et al. Arthroscopic synovectomy of the knee joint for rheumatoid arthritis. Int Orthop. 2019; 43:1859–1863.

8. Roth JH, Poehling GG. Arthroscopic "-ectomy" surgery of the wrist. Arthroscopy. 1990; 6:141–7.

9. Adolfsson L, Frisen M. Arthroscopic synovectomy of the rheumatoid wrist: a 3.8 year follow-up. J Hand Surg Br. 1997; 22:711–3.

10. Kim SJ, Jung KA. Arthroscopic synovectomy in rheumatoid arthritis of wrist. Clin Med Res. 2007; 5:244–50.

11. Felson DT, Anderson JJ, Boers M, et al. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995; 38:727–35.

12. Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011; 63:573–86.

13. Rau R, Herborn G. A modified version of Larsen's scoring method to assess radiologic changes in rheumatoid arthritis. J Rheumatol. 1995; 22:1976–82.

14. Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet. 2017; 389:2338–48.

15. Brown AK, Quinn MA, Karim Z, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum. 2006; 54:3761–73.

16. Ostergaard M, Møller-Bisgaard S. Rheumatoid arthritis: Is imaging needed to define remission in rheumatoid arthritis? Nat Rev Rheumatol. 2014; 10:326–8.