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The Musculoskeletal System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Basic treatment of rheumatoid arthritis involves rest (splinting), passive exercise and heat, and emotional support. Anti-inflammatory and analgesic agents are used for pain and management of inflammation. If this is not sufficient, goldsalts, methotrexate, antimalarial drugs, penicillamine, azathioprine, or corticosteroids may be effective. Surgical procedures include joint replacement and synovectomy.
Animal Models of Rheumatoid Arthritis
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Erica L. Moran, Earl R. Bogoch
The role of synovectomy in the management of inflammatory arthritis has been controversial for 40 years. Surgical synovectomy of joints was introduced to the management of RA by Vainio and Laine, in the 1950s in Heinola, Finland. Other methods of synovectomy have been applied, including chemical ablation of the synovium with osmic acid, radiosynoviorthesis or radiosynovectomy by injection of radioisotopes of gold, yttrium, rhenium, and strontium, and by less invasive means of surgical synovectomy utilizing the arthroscope. The original focus of joint synovectomy was the knee, but most of the other joints have been treated by synovectomy.
Klippel–Trenaunay syndrome: Pain and psychosocial considerations
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Jamison Harvey, Megha M. Tollefson, Peter Gloviczki, David J. Driscoll
Arthritis occurs in a small number of patients with KTS, but in those patients, it is a major problem. Usually it involves the knee but can also involve the ankle. Destruction of cartilage occurs likely from recurrent hemarthrosis when the vascular malformation is within a joint. The presence of the vascular malformation may create a chronic synovitis. Patients typically try to limit pain by flexing the knee and can develop a flexion contracture (Figure 84.3). Treatment includes analgesics and maneuvers to prevent the flexion contracture. This may involve physical therapy, passive stretching, and bracing. Synovectomy may be useful. If the flexion contracture is severe enough to prevent walking and the leg cannot be straightened, amputation may be necessary to control the pain and allow the patient to walk with a prosthesis.
Synovitis in hemophilia: preventing, detecting, and treating joint bleeds
Published in Expert Review of Hematology, 2023
In 1985 Wiedel reported for the first time the value of arthroscopic synovectomy in CHS, with satisfactory results [85]. In 1987, Klein et al also advised early arthroscopic synovectomy for the treatment of repeated hemarthrosis in PWH [86]. In 1997 Eickhoff et al reported that arthroscopic surgery, a relatively low risk technique, can be used to achieve satisfactory results in PWH [87]. In 2007 Verma et al reported that the results of arthroscopic synovectomy demonstrated a remarkable decline in hemarthrosis and substantial improvements in pain, range of motion, and function [88]. The principal predictor of outcome was the degree of preexisting degenerative changes within the joint. In more severe cases, the results of arthroscopic synovectomy were unpredictable, and in those cases, consideration should be given to total joint replacement.
Bone change after surgical treatment of mucous cyst at the interphalangeal joint of the great toe in a patient with rheumatoid arthritis
Published in Modern Rheumatology, 2019
Rie Kurose, Dai Tanaka, Yasuyuki Ishibashi
On pathological examination, synovitis was not so strong, namely whether mucous cyst in our case was associated with synovitis has been still unknown. However, there are recent reports describing synovectomy for finger joints in patients with RA before bone changes occur contributes to slowing down of the progression of bone changes [10,11]. Synovectomy for finger joints is the recommended surgery when chronic synovitis of the finger joints does not respond to any other conservative treatment. Although she could not take medication for RA because of the renal dysfunction, bone erosion healing was shown after the synovectomy and the disease activity of RA has also improved. In cases of mucous cyst complicated with RA, a combination of synovectomy with surgical treatment of mucous cyst might be effective and recommended.
Hemophilic arthropathy: current treatment challenges and future prospects
Published in Expert Opinion on Orphan Drugs, 2018
The best treatment for synovitis is synovectomy. Synovectomy can be of two basic types: radiosynovectomy and arthroscopic synovectomy [9,24]. Both are equally effective in alleviating the problem, although radiosynovectomy has a cost of approximately 2,500 euros in factor expenses, whereas arthroscopic synovectomy costs 10 times more (25,000 euros in factor expenses). In addition, arthroscopic synovectomy is a surgical procedure that requires general anesthesia and hospital admission. Radiosynovectomy is performed on an outpatient basis in the Department of Nuclear Medicine with the help of specialists who prepare the isotopes to be injected into the affected joint. In our center, we use yttrium-90 for knees and rhenium-186 for elbows and ankles at minimum radiation doses (Table 1). In addition, the isotope is always injected inside the joint, which is verified by a postinjection scintigraphy (Figure 4). Radiosynovectomy can be repeated up to two times a year as many times as appropriate. We indicate it when the patient has had two or more hemarthroses in the previous 6 months. After a radiosynovectomy, the average decrease in recurrent hemorrhages is 65% [24,25].