The influence of knee synovectomy on the course of disease in patients suffering from rheumatoid arthritis (RA)

There is no doubt that RA takes a more favourable course with continuous conservative treatment than with occasional medical supervision. With skilful application of the conservative treatment, the state of health in part of the patients can be kept stable over a longer period. Despite this conservative treatment, however, a number of patients continually experience new episodes of inflammation which can lead to severe disablement of the patient if the disease progresses extremely unfavourably (4,13,18). We endeavour to remedy or reduce disablements occurring in this manner by means of reconstructive surgery (arthrodeses, arthroplasties, reconstructive tendon operations etc.). The decision to undertake such reconstructive operations as well as the evaluation of the respective operation results are left exclusively to the operating surgeon because such operations are limited to local corrections (16). Synovectomies are quite different. The introduction of synovectomy in the treatment programme for RA patients has opened the way for new expectations. Apart from the purely local treatment, they also concern the general therapeutic and preventive possibilities. To clarify the question of the preventive and general therapeutic effects of synovectomy, it is necessary for the rheumatologist and the surgeon to cooperate closely. In contrast to reconstructive operations, it is important for both of them to agree on the patients selected for operation and the time it should be carried out. This also applies to the post-operative treatment and the evaluation of the immediate and long-term results.