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Zur Effektivität der arthroskopischen Synovektomie bei rheumatoider Arthritis

Effectiveness of arthroscopic synovectomy in rheumatoid arthritis

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Zusammenfassung

Die Effektivität der arthroskopischen Synovektomie ist sowohl für die Gelenke der oberen Extremität (Schulter, Ellenbogen, Handgelenk) als auch für das Kniegelenk in zahlreichen Studien belegt. Der Effekt dieses Eingriffs besteht in einer Schmerzreduktion sowie in einem Zugewinn der Gelenkbeweglichkeit, wobei die langfristigen Ergebnisse bei allenfalls geringer Gelenkschädigung zum Zeitpunkt der Operation (Frühsynovektomie) gegenüber denen bei bereits fortgeschrittener Gelenkdestruktion (Spätsynovektomie) überlegen sind. Limitationen bestehen für die Arthroskopie des kontrakten rheumatischen Ellenbogens wegen einer relativ hohen Komplikationsrate, für die Fingergelenke wegen der fehlenden Erreichbarkeit der palmaren Gelenkanteile sowie für das rheumatische Sprunggelenk, für das zur Synovektomie des dorsalen Gelenkanteils meist eine zusätzliche dorsale Arthrotomie erforderlich ist.

Gelenkunabhängig ist ein offenes Vorgehen immer dann sinnvoll, wenn auf diese Weise extraartikuläre Begleitpathologien korrigiert werden können.

Abstract

Arthroscopic synovectomy in rheumatoid arthritis has proven beneficial in terms of pain relief and joint function, both for upper limb joints (shoulder, elbow, wrist) and the knee. The clinical long-term improvement, such as pain reduction and improved joint mobility, seems more distinct in joints with no or mild joint destruction (early synovectomy) compared to advanced joint damage (late synovectomy). Late-stage elbow arthritis, synovitis of the metacarpophalangeal and proximal interphalangeal joints and the rheumatoid ankle can better be addressed by an open approach. Although a real joint-preserving effect has not been demonstrated, pain reduction and improvement in joint function recommend arthroscopic synovectomy as a substantial treatment option in patients with rheumatoid arthritis.

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  1. Orthopädisch-Rheumatologische Abteilung der Friedrich-Alexander-Universität Erlangen-Nürnberg, Im Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054, Erlangen, Deutschland

    H.-D. Carl & B. Swoboda

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  1. H.-D. Carl
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  2. B. Swoboda
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Correspondence to H.-D. Carl.

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Carl, HD., Swoboda, B. Zur Effektivität der arthroskopischen Synovektomie bei rheumatoider Arthritis. Z. Rheumatol. 67, 485–490 (2008). https://doi.org/10.1007/s00393-008-0314-5

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