Abstract
To investigate whether arthroscopic synovectomy is effective for nonresponders to infliximab, anti-tumor necrosis factor-α antibody, for the treatment of rheumatoid arthritis (RA), we assessed seven patients including ten arthroscopic synovectomies in knee joint, in shoulder joint, and in ankle joints. We compared C-reactive protein (CRP) and DAS28 (ESR) before and after surgery at 6 and 50 weeks. After arthroscopic synovectomy, we continued the infliximab treatment with methotrexate in a routine manner. We detected synovium proliferation with vascular increase in patellofemoral joint and around the meniscus and femoral and tibial side of the anterior cruciate ligament in the knee joints. We also found synovial proliferation in rotator interval in the glenohumeral joint and fatty changing in subacromial bursa in the shoulder. In the ankle joint, we found synovial proliferation with white meniscoid between tibiofibular joint to develop impingement. Serum CRP was improved from 3.45±0.4 to 1.12±0.2 at 6 weeks to 1.22±0.4 at 50 weeks after arthroscopic synovectomy. There is no severe side effect of arthroscopic synovectomy during infliximab treatment; however, one patient had slight rash that was improved. DAS28 was improved from 5.58±0.23 to 3.87±0.47 at 6 weeks to 2.58±1.49 at 50 weeks after arthroscopic synovectomy. It is possible that arthroscopic synovectomy can be one of the effective methods to continue with the infliximab treatment when its efficacy decreased or in the nonresponders of infliximab for RA patients.
Similar content being viewed by others
References
Latosiewicz R, Murawski J (1994) Arthroscopic knee joint synovectomy in the treatment of early stages of rheumatoid arthritis. Rocz Akad Med Bialymst 39:25–30
Roch-Bras F, Daures JP, Legouffe MC, Sany J, Combe B (2002) Treatment of chronic knee synovitis with arthroscopic synovectomy: long term results. J Rheumatol 29:1171–1175
Maini RN, Breedveld FC, Kalden JR, Smolen JS, Furst D, Weisman MH, St.Clair EW, Keenan GF, van der Heijde D, Marsters PA, Lipsky PE (2004) Sustained improvement over two years in physical function, structural damage, and signs and symptoms among patients with rheumatoid arthritis treated with infliximab and methotrexate. Arthritis Rheum 50:1051–1065
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Steinbrocker O, Traeger CH, Battman RC (1949) Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662
Kanbe K, Takagishi K, Chen Q (2002) Stimulation of matrix metalloprotease 3 release from human chondrocytes by the interaction of stromal cell-derived factor 1 and CXC chemokine receptor 4. Arthritis Rheum 46:130–137
Kanbe K, Takemura T, Takeuchi K, Chen Q, Takagishi K, Inoue K (2004) Synovectomy reduces cell-derived factor-1 (SDF-1), which is involved in cartilage destruction in osteoarthritis and rheumatoid arthritis. J Bone Joint Surg 86:296–300
Matsui N, Taneda Y, Ohta H, Itoh T, Tsuboguchi S (1989) Arthroscopic versus open synovectomy in the rheumatoid knee. Int Orthop 13:17–20
Weinstein DM, Bucchieri JS, Pollock RG, Flatow EL, Bigliani LU (2000) Arthroscopic debridement of the shoulder for osteoarthritis. Arthroscopy 16:471–476
Doets HC, Bierman BT, Von Soesbergen RM (1989) Synovectomy of the rheumatoid knee does not prevent deterioration. Acta Orthop Scand 60:523–525
Smiley P, Wasilewski S (1990) Arthroscopic synovectomy. Arthroscopy 6:18–23
McEwen C (1988) The treatment of rheumatoid arthritis: report of results at the end of five years. J Rheumatol 15:764–769
Nakamura H, Nagashima M, Ishigami S, Wauke K, Yoshino S (2000) The anti-rheumatic effect of multiple synovectomy in patients with refractory rheumatoid arthritis. Int Orthop 24:242–245
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kanbe, K., Inoue, K. Efficacy of arthroscopic synovectomy for the effect attenuation cases of infliximab in rheumatoid arthritis. Clin Rheumatol 25, 877–881 (2006). https://doi.org/10.1007/s10067-005-0129-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-005-0129-6