Long-term results of multiple synovectomy for patients with refractory rheumatoid arthritis. Effects on disease activity and radiological progression.

OBJECTIVES We developed a radical multiple synovectomy (RaMS) procedure designed to reduce disease activity in refractory RA patients involving the excision of all inflamed synovial tissues. In this study we examined the long-term outcome of RaMS in terms of disease activity and articular destruction. METHODS Forty-two patients with refractory RA underwent RaMS and were followed up for an average of 7.3 years. Clinical findings and radiological outcome were evaluated and compared to a control group. RESULTS More than 40% of patients continued to maintain improvement up to 4 years after the operation. The number of swollen joints and painful joints, the erythrocyte sedimentation rate, CRP and rheumatoid factor quickly decreased after the operation. The beneficial effects continued for 4 years compared to patients treated with combination disease modifying anti-rheumatic drug therapy. The damage score worsened less rapidly in patients undergoing RaMS than in the control group. Articular destruction was less marked in the PIP, MP, wrist and ankle joints of patients who responded well to RaMS. CONCLUSIONS RaMS was effective for refractory RA in the short term and seemed to offer some advantages over other therapies in terms of slowing articular destruction. However, RaMS did not radically alter the natural disease course of RA.