Fig 2 - uploaded by Samarth Mittal
Content may be subject to copyright.
Source publication
Objective:
To determine the long-term clinical and functional results of arthroscopic elbow synovectomy in rheumatoid arthritis patients with refractory elbow synovitis in terms of improvement in pain, function, and active range of motion (AROM) or arc of motion.
Method:
Fifteen rheumatoid elbows in 13 patients, not responding to DMARD therapy a...
Similar publications
Objectives:
To evaluate grey scale US (GSUS) and power Doppler US synovitis (PDUS), separately or in combination (CombUS), to predict joint damage progression in RA.
Methods:
In this cohort study nested in the Swiss RA register, all patients with sequential hand radiographs at their first US assessment were included. We analysed the summations o...
Background
Ongoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage.
Objective
To study the feasibility and repeatability of T1ρ for assessing knee cartilage in JIA and also to describe T1ρ values and study correlation between T1ρ and conventional MRI scores for disease activity.
Materials and methods...
Zusammenfassung
Die Osteoarthrose ist die häufigste Ursache für den Hüftschmerz des Erwachsenen. Daher wird anderen Ursachen wie z. B. Entzündungen weniger Beachtung für den Gelenkschmerz in der Erstdiagnose geschenkt. Dieser Artikel gibt eine Übersicht von unterschiedlichen rheumatologischen Erkrankungen der Hüfte und deren Interpretation in der B...
Citations
... Also, surgery cannot be performed repeatedly (Yasutaka et al., 2016). Compared with traditional surgery, arthroscopic synovectomy truly has some advantages, however, it still have some blind spots (Vivek et al., 2016). Other treatment measures such as chemical synovectomy and radio-surgical resection can reduce joint exudation and prevent cartilage protection, but they could cause damage to other normal tissues (Winkler et al., 2013). ...
Rheumatoid Arthritis is a universal disease that severely affects the normal function of human joints and the quality of life. Millions of people around the world are diagnosed with rheumatoid arthritis every year, carrying a substantial burden for both the individual and society. Hydrogel is a polymer material with good mechanical properties and biocompatibility, which shows great potential in the treatment of rheumatoid arthritis. With the progress of tissue engineering and biomedical material technology in recent years, more and more studies focus on the application of hydrogels in rheumatoid arthritis. We reviewed the progress of hydrogels applied in rheumatoid arthritis in recent years. Also, the needed comprehensive performance and current applications of therapeutic hydrogels based on the complex pathophysiological characteristics of rheumatoid arthritis are also concluded. Additionally, we proposed the challenges and difficulties in the application of hydrogels in rheumatoid arthritis and put forward some prospects for the future research.
... Identification with additional synovitis diseases is necessary before diagnosis, including rheumatoid synovitis, gouty synovitis, infectious synovitis, pigmented villonodular synovitis, and synovial chondromatosis [10][11][12][13][14][15] . As the optimal detection of RBS, MRI findings are very typical. ...
Background:
Rice body synovitis (RBS) is a rare disease. It is prone to be developed due to rheumatoid disorder or tuberculosis infection. Additional infectious arthritis (non-tuberculous mycobacterial infection and fungal infection), juvenile arthritis, the onset of adult Still's disease, systemic lupus erythematosus (SLE), seronegative arthritis, and non-specific arthritis. The clinical imaging, histopathological features, and surgical treatment process of a patient were documented combined with literature. Furthermore, differentiation was performed with additional synovitis diseases so that the cognition of synovitis could be enhanced for clinical reference.
Case presentation:
The present study reported a 50-year-old female patient who suffered from intermittent left knee pain with limited movement for 9 years. The conditions were aggravated after long-term standing or walking and remitted after taking a rest, accompanied by noose and jamming. The specialist range of motion (ROM) examinations of the left knee revealed: 30° - 0° - 110° and left McMurray sign (+). Plain MRI scanning revealed that in the left knee cavity and the popliteal fossa area, a large number of low signals on free rice-like bodies were visible inside and the lower femur and the upper tibia exhibited abnormally high signals of patchy lipography. Surgical exploration revealed numerous rice-like free bodies in the suprapatellar bursa, the intercondylar fossa, and the posterior articular capsule. The patient presently has resolution of symptoms after surgical treatment.
Conclusions:
The RBS of the knee joint is very rare in the clinic. As MRI examination can provide valuable information, clinicians should actively perform MRI examination. Once the disease is diagnosed by examination, surgery is the optimal treatment.
... However, repeated local injections increase the tendency toward infection and crystallization, causing poor compliance [3]. Arthroscopic synovectomy can also relieve the symptoms temporarily, but patients usually relapse within half a year, sometimes even progressing to a more serious condition because of incomplete resection and the inability to reverse synovial pathology [4]. Therefore, a long-acting therapy administered locally to the joints is urgently needed in the clinic. ...
Background
Persistent synovial hyperplasia with inflammation in rheumatoid arthritis is one of the main pathogeneses of refractory rheumatoid arthritis (RRA). Photodynamic therapy (PDT) causes less trauma than steroid injections or arthroscopic synovectomy while providing stronger targeting and more durable curative effects. The aim of this trial was to evaluate the short-, medium-, and long-term clinical efficacy of PDT when applied as a treatment for RRA synovial hyperplasia and synovitis.
Methods and analysis
This protocol is for a single-center, randomized, double-blind, blank-controlled prospective trial. A sample of 126 RRA patients will be randomly divided into 3 groups: the control group, the “PDT once” group, and the “PDT twice” group, with 42 participants per group. The trial will be conducted by the Rheumatology and Immunology Department of the Integrated Hospital of Traditional Chinese Medicine, Southern Medical University. The Ultrasound Compound Score of Synovitis (UCSS) has been selected as the primary outcome measure. The secondary outcome measures include knee joint clinical assessments, ratio of relapse, duration of remission, Disease Activity Score in 28 joints (DAS28), inflammation indexes, serum concentrations of specific antibodies, and changes in articular structures as detected by X-ray scans in the 48th week. The improvement ratios of the UCSS at the 8th, 24th, and 48th weeks (compared with baseline) reflect short-, medium-, and long-term time frames, respectively.
Ethics and dissemination
The protocol was approved by the Medical Ethics Committee of the Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, China (Approval No. granted by the ethics committee: NFZXYEC-2017-005) and then entered in the Chinese Clinical Trials Registry under registration number ChiCTR1800014918 (approval date: February 21, 2018). All procedures are in accordance with Chinese laws and regulations and with the Declaration of Helsinki by the World Medical Association (WMA). Any modifications of this protocol during execution will need additional approval from the Ethics Committee of our hospital.
Trial registration number
ChiCTR1800014918.
... The continuous curative effect of long-term treatments is poor and can easily cause inflammation and crystallisation; furthermore, patient compliance is also poor [3]. Arthroscopic synovectomy shows some improvement over steroid injection, but it is a limited invasive treatment that can result in large injuries and cannot completely excise the synovium; additionally, it is unable to change the characteristics of the synovial pathology, and symptoms can recur in half a year or even sooner [4]. There remains a need for therapy with long-term efficacy for joint local treatment in the clinic. ...
Background Persistent synovial hyperplasia with inflammation in rheumatoid arthritis is the main cause of refractory rheumatoid arthritis (RRA). As a means of local treatment, photodynamic therapy (PDT) confers less trauma, stronger targeting, and more durable curative effects than steroid injections or arthroscopic synovectomy. The aim of this trial will be to evaluate the short-, medium- and long-term clinical efficacy of PDT in the treatment of RRA synovial hyperplasia and synovitis.
Methods and analysis This is a single-centre, randomised, double-blind, blank-controlled, prospective trial. A sample of 126 RRA patients will be randomly divided into 3 groups: the control group, the PDT once group, and the PDT twice group, 42 per group. The trial will be conducted at the Rheumatology and Immunology Department of Integrated Hospital of Traditional Chinese Medicine, Southern Medical University. Assessments at baseline, the first operation, the second operation (4th week), and then at three follow-ups (8th week, 24th week, 48th week) will be performed. The Ultrasound Compound Score of Synovitis (UCSS), knee joint clinical assessments, Disease Activity Score in 28 Joints (DAS28), serological inflammation indexes and specific antibody levels, pathological biopsies of synovial tissue and X-ray assessments of bone destruction will be evaluated. An improvement in the UCSS will be the main endpoint, and the UCSS at the 8th week versus the baseline value will reflect the short-term outcome of the operation. The results of the 24th week and 48th week follow-up will reflect the medium- and long-term curative effects, respectively.
Ethics and dissemination The protocol was approved by the Medical Ethics Committee of Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, China (Approval No. of the ethics committee: NFZXYEC-2017-005) and later registered in the Chinese Clinical Trials Registry with Registration number ChiCTR1800014918 (approval date: February 21, 2018). All procedures will be in accordance with Chinese laws and regulations, as well as the WMA Declaration of Helsinki. Any modifications to the protocol will be approved by the Ethics Committee of our hospital.
Trial registration number ChiCTR1800014918.
... Rheumatoid arthritis is characterized by swelling in the joints, tenderness on palpation, morning stiffness, decreased range of motion, and weakening in the muscles due to them [71][72][73]. Therefore, the presence of posture, atrophy, swelling, scar tissue, skin changes, and deformity should be observed with the inspection [74,75]. ...
... Rheumatoid arthritis is characterized by swelling in the joints, tenderness on palpation, morning stiffness, decreased range of motion, and weakening in the muscles due to them [71][72][73]. Therefore, the presence of posture, atrophy, swelling, scar tissue, skin changes, and deformity should be observed with the inspection [74,75]. ...
Rheumatoid arthritis is a progressive, chronic, and degenerative disease that adversely affects the quality of life of individuals. Depending on the individual’s symptoms of rheumatoid arthritis, basic and instrumental daily life activities are restricted, and participation of life is adversely affected. Occupational therapy interventions for rheumatoid arthritis rehabilitation include self‐management programs (e.g., arthritis self‐management program, bone up on arthritis, self‐management arthritis treatment physical activity), splinting techniques for rheumatoid arthritis, and vocational rehabilitation. In this chapter, updated information about these approaches is brought together and presented to the reader.
Background:
Surgical treatment can be considered for patients with undifferentiated arthritis (UA) limited to the elbow joint. The purpose of this study was to analyze the clinical outcomes of arthroscopic synovectomy.
Methods:
Nineteen patients who underwent arthroscopic synovectomy for chronic UA of the elbow between 2006 and 2019 were enrolled in this study. One patient was excluded because of evidence of tuberculosis in the biopsy. Chronic UA of the elbow was defined as (1) localized synovitis diagnosed by magnetic resonance imaging, (2) no specific cause, and (3) no response to conservative treatment for >3 months. We compared baseline characteristics and clinical outcomes between the remission and disease progression groups.
Results:
Postoperatively, synovitis was controlled in 13 patients. In 5 patients, the symptoms disappeared after surgery without any medical treatment. Four patients discontinued disease-modifying antirheumatic drugs. Nine patients were classified as in remission. The disease progression group had a longer symptom duration, elevated rheumatoid markers, and higher Larsen grading. However, the difference was not statistically significant.
Conclusions:
Arthroscopic synovectomy achieved remission in approximately 47% of patients with chronic UA of the elbow. Although arthroscopic synovectomy did not prevent RA, it can be considered for rapid resolution of synovitis and diagnostic purposes.
Introduction:
Arthritis is affecting millions of people globally, involvement and distribution depending on the type of arthritis. The most common arthritic conditions are osteoarthritis (OA) and Rheumatoid arthritis (RA). Despite the pathogeneses being fundamentally different, both joint diseases share the same need for local treatment of synovitis.
Evidence acquisition:
No current treatment can stop the progression of OA. Local articulate treatment including glucocorticoid (GC) injections, radiosynoviorthesis (RSO) and surgical synovectomy are the only options to relieve pain and temporally improve movability before surgical intervention. For RA, despite effective systemic treatments, similarly need for local articulate treatment is still present, especially early in the disease, but also in case of recurrent episodes of disease flare.
Evidence synthesis:
Current evidence supports local GC injection as first line treatment for persistent synovitis in a single or a few joints. RSO provides an evident and effective alternative for GC refractory synovitis, especially in early RA. Surgical synovectomy is an invasive alternative, but with less documented efficacy. Whether one unsuccessful intraarticular GC injection is enough to change of mode of action for local treatment is still unclear and needs to be further investigated.
Conclusions:
In conclusion persistent single joint synovitis in OA and RA is well treated with local treatment. Intra-articular GC injection is considered as first line of treatment, but RSO provides an additional treatment alternative with less side effects and better evidence of efficacy than surgical synovectomy.
Inflammatory arthritis of elbow at the outset may present with pain, swelling, and restriction of movements, while deformities are associated with chronic cases. Surgical intervention is the mainstay of treatment, especially in rheumatoid elbow not responding to conservative management and disease-modifying anti-rheumatoid drug (DMARD) therapy. Traditionally, open procedures along with radial head resection were the most popular procedures and associated with severe morbidities as elbow joints are very notorious for being stiff after any manipulation or surgical intervention. With the advent of new techniques, equipment, and surgical skills, it is convenient to perform synovectomy, debridement, and decompression of elbow joint with keyhole arthroscopic surgeries, which are becoming very popular to improve arc of motion and pain relief with minimal postoperative morbidity as it allows early rehabilitation. Recent literature has documented effectiveness of arthroscopic synovectomy in inflammatory arthritis (mild-to-moderate severity) of elbow at short-term as well as long-term follow-up. Arthroscopic surgery of elbow is more demanding than open procedures so a steep learning curve may be expected for surgeons.
Rheumatoid arthritis (RA) is a common chronic autoimmune disease that results from synovial hyperplasia. The hyperplasia of synovium directly degrades cartilage by secreting matrix-degrading enzymes and inducing cartilage degradation and even loss of joint function. In this study, a metal/semiconductor composite, octahedral copper sulfide shell, and gold nanorod core (Au [email protected]) is designed for, photothermal therapy (PTT), photodynamic therapy (PDT), and chemotherapy (CT) combination therapy for RA to remove hyperplasia of the synovium. Upon laser irradiation, the coupling of the local surface electromagnetic field improves the electromagnetic field of the Au NR core and the absorption of light of the CuS shell, whereby the photothermal effect is enhanced. Due to the Fenton-like reactions and the integration of Au NR and CuS semiconductor photocatalyst inhibits hole recombination and provides a reaction site for photocatalysis, which introduces additional •OH to photodynamics therapy. In addition, the large octahedral void space in Au [email protected] NPs can be used for loading a high quantity of drugs for chemotherapy, and modified with vasoactive intestinal peptide and hyaluronic acid (HA) formation VIP-HA-Au [email protected] NPs to target synovial cells in RA. Under combination therapy, VIP-HA-Au [email protected] NPs were shown to effectively inhibit the synovial cells and the edema degree of the CIA mouse was alleviated apparently. Both in vitro and in vivo studies indicate that the VIP-HA-Au [email protected] NPs can provide a potential possibility for the treatment of RA.
