Effect of Etanercept Combined with Synovectomy on Function and Serum Levels of Associated Factors in AS Patients with Coexisting Coxarthrosis

Objective To investigate the clinical effect and value of etanercept combined with arthroscopic synovectomy in the treatment of ankylosing spondylitis (AS) complicated with coxarthrosis. Methods 66 patients with AS complicated with coxarthrosis admitted in our hospital were taken as the study objects and were randomly divided into two groups with random number table: test group (n = 33) and control group (n = 33). The arthroscopic synovectomy was given to both groups. The control group was given basic anti-inflammatory and analgesic measures, promoting blood circulation and detumescent measures after surgery, and the test group was added with etanercept on the basis of the control group. Changes in scores of coxae function, serum transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) at different time after operation were compared between the two groups. Results There was no significant difference in Harris score between the test group and the control group before operation (P>0.05). The Harris score of the test group was higher than that of the control group 3 months after operation and 6 months after operation (P<0.05). There was no statistically significant difference in the determination of flexion angle and abduction angle of coxae between the test group and the control group before operation (P>0.05). The flexion angle and abduction angle of coxae of the test group were higher than that of the control group 6 months after operation (P<0.05). The difference of measured values of serum levels TGF-β1, TNF-α, IL-6, CRP and ESR in the test group and the control group had no statistical significance (P>0.05). The determination values of serum levels TGF-β1, TNF-α, IL-6, CRP and ESR in the test group were lower than those in the control group at 3 months after operation (P<0.05). Conclusion Etanercept combined with arthroscopic synovectomy for the treatment of AS complicated with coxarthrosis is beneficial to regulate the level of related cytokines and promote the recovery of postoperative joint function.

Postoperative radiotherapy for pigmented villonodular synovitis (PVNS): case series and literature review

Purpose: Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disease of the synovium with locally aggressive behaviour. We reviewed our experience using external beam radiotherapy (RT) in the treatment of PVNS. Method: We report five cases of PVNS who underwent Arthroscopic Synovectomy followed by postoperative RT in National Oncology centre in Oman. The total dose RT ranges between 30 and 36 Gray (Gy) Three-dimensional radiotherapy technique. Conclusion: Postoperative RT is effective in preventing disease recurrence and should be offered following maximal cytoreduction to enhance local control in PVNS.

Subacromial impingement by a lipoma arborescens

Subacromial impingement syndrome (SIS) is the leading cause of shoulder pain. A systemic approach for abnormal causes of SIS is recommended to avoid misdiagnosing rare or sinister pathologies. To our knowledge, only nine cases of subacromial lipoma arborescens associated with impingement syndrome have been reported in the literature. In this report, we briefly discuss histopathologic and radiological signs of an unusual case of impingement syndrome caused by subacromial “lipoma arborescens” and describe arthroscopic synovectomy after the failure of conservative management. The patient remains symptom-free five years after surgery.

Treatment of Primary Intra-Articular Pigmented Villonodular Synovitis of the Knee by Using Complete Arthroscopic Synovectomy and Postoperative Low-Dose Radiotherapy

BackgroundPigmented villonodular synovitis (PVNS) is a locally aggressive, proliferative synovial tissue disorder, the optimal treatment regimen for diffuse PVNS is still undefined. The aim of this study was to evaluate the long-term clinical outcome of the treatment of complete arthroscopic synovectomy combined with low-dose external radiotherapy in the knee affected by primary intra-articular diffuse PVNS.MethodsA series of 18 patients diagnosed with primary diffuse PVNS by clinical and pathological examination were enrolled in this study from May 2009 to January 2016. All patients underwent complete arthroscopic synovectomy and postoperative local low-dose (20 Gy) external radiotherapy, and were evaluated before treatment and final follow-up using the criteria of Ogilvie-Harris and International Knee Documentation Committee (IKDC) score.ResultsThe patients were followed-up for a mean of 68 months (35 to 120 months). No recurrence was found. No surgical and radiation-related complications were observed. The mean score according to Ogilvie-Harris criteria was 3.19 which rated as poor, and the IKDC function score was 37.1±3.8 before treatment. At the final follow-up, the mean score of Ogilvie-Harris was 8.79 which rated as good, and the IKDC score was 83.9±11.3 (p<0.05).ConclusionTreatment for primary intra-articular diffuse PVNS in the knee with complete arthroscopic synovectomy and postoperative low-dose external radiotherapy had good clinical outcome with no complication and recurrence.

The Adequacy of Evaluation by Rheumatologists before Undergoing Arthroscopic Synovectomy in Rheumatoid Arthritis Patients

Purpose: The purpose of this study was to evaluate the relationship between the progression of arthritis and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) through the treatment-resistant mono joint rheumatoid arthritis treated with arthroscopic synovectomy.Methods: We retrospectively reviewed 65 patients who underwent arthroscopic synovectomy for rheumatoid wrist or elbow which had not responded to systemic treatment for at least 6 months. The main treatment response evaluation methods of rheumatologists were the American College of Rheumatology (ACR) response criteria, and the ACR/EULAR (European League Against Rheumatism) remission criteria. The medical records, results of laboratory tests and radiographs of wrist or elbow that had been performed by rheumatologists before arthroscopic synovectomy were investigated. We examined whether the results of laboratory tests and arthritic change of radiograph had statistically significant correlation. Results: The mean duration of joint symptom until referral to orthopedic department was 23 months (range, 1 month to 9.2 years). During this period, rheumatologists had took average one X-ray (range, 0–3). Forty-seven patients (72.3%) had CRP of 1 mg/dL or less as included in the ACR/EULAR remission criteria. Seventeen out of 65 patients who had two or more X-ray were able to evaluate the progression of arthritis. The change of arthritis and mean ESR (p=0.787) or CRP (p=0.303) the same period didn’t have statistically significant relationship (Spearman correlation analysis).Conclusion: Since the method of evaluating the treatment response of rheumatologists is to assess the systemic condition, arthritis of one joint that is resistant to treatment is considered to require periodic radiographs as method to assess itself.