Long-term results of synovectomy of the finger joints in rheumatoid arthritis

Abstract

The effectiveness of surgical synovectomy of finger joints were clinically and radiologically evaluated. One hundred and sixty-one finger joints (MP 72, PIP 70, DIP 10 and IP 9) of 64 hands of 52 patients with rheumatoid arthritis who had a surgical synovectomy were examined at an average of 6.7 years follow-up (range 5.2–17 years). The results of synovectomy in these patients were evaluated according to five factors: recurrence of synovial swelling, relief of pain progression of deformity, progression of radiological change, and changes in range of motion after surgery. Un-operated fingers which were not swollen at the time of surgery were used as the controls. Recurrence of synovial swelling was seen in 12% of the patients at the follow-up examination and pain in the finger joints had developed in 6%. In almost all patients, the anti-inflammatory effects of surgery persisted for more than 5 years. Twenty-two (14%) PIP and MP joints showed postoperative progression of clinical deformity. Fifty-seven joints (35%) showed progression of bone change or articular rheumatoid lesion upon radiological examination. Each of the four clinical factors (pain, swelling, deformity and motion) improved more in the treated fingers than the un-operated control fingers. Although only 33% of the MP and PIP joints experienced no loss of motion in the operated joints after surgery, loss of motion occurred to only a small extent (10–15°) and few patients experienced difficulties with daily activities. The results of this clinical study suggest that surgical synovectomy for rheumatoid finger joints has anti-inflammatory effects as well as a prophylactic effect on the development of deformity and the progression of bony change after surgery.