Thursday, January 27, 2011

Removing the Synovium in an Inflammed RA Joint

In the previous post, we discussed different types of surgeries which are used in patients with rheumatoid arthritis.  This week I’d like to talk more about surgeries involving soft-tissue, specifically synovectomy, tendon repair, and carpal tunnel release.

What is a Synovectomy?

The synonium is a membrane surrounded a joint, usually only one or two cell layers thick, which produces synovial fluid to help lubricate the joint.  In rheumatoid arthritis, the synovium becomes inflamed and may grow excessively, producing too much synovial fluid containing an enzyme that can eat away at the cartilage on the joint surface.  Disease-modifying anti-rheumatic drugs (DMARDs) are used to control the abnormal growth of synovium.

If DMARDs do not work, a patient’s rheumatologist may suggest steroid injections into a joint or a needle aspiration of excess synovial fluid.  If these strategies do not work, then the patient may be referred to an orthopedic surgeon to discuss the removal of the synovium.  This surgery is called a synovectomy and can be done as an open surgical procedure or through arthroscopic surgery.

Synovectomies are performed are knees, elbows, wrists, finger joints, and hips.  The surgery typically produces better results when the patient’s cartilage has not been eroded, thus it is recommended for patients who are in earlier stages of their disease.  Note that over time the synovium may grow back and require repeat surgery.

Read this post in its entirety:

Soft-Tissue Surgery in Rheumatoid Arthritis: Synovectomy, Tendon Repair, Carpal Tunnel Release

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