S62 ARTHROSCOPIC SYNOVECTOMY FOR THE EFFECT ATTENUATION CASES OF INFLIXIMAB IN RHEUMATOID ARTHRITIS

Abstract

Purpose: In order to investigate if arthroscopic synovectomy is effective for non-responder by infliximab, anti-TNF-α antibody, for rheumatoid arthritis (RA), we assessed 7 patients including 10 arthroscopic synovectomy including in knee joint, in shoulder joint and in ankle joints respectively.

Materials and Methods: We performed arthroscopic synovectomy in 10 joints of 7 patients to compare CRP and DAS28 before and after surgery at 6 and 50 weeks. Those patients include 1 male and 6 female from 49 to 68 years old with average of 62 years old. 3 patients was underwent arthroscopic synovectomy after 4 times of infliximab, 2 patients were after 5 times and 2 patient was 6 times. All patients were initially responder to infliximab and MTX but gradually the effect decreased, the average of CRP was 3.45±0.4 (2.7–5.6) mg/dl at the surgery. The indication of operation was that after treatment infliximab CRP was more than 2.5 mg/dl and the numbers of arthritis joints were limited to within five joints of relatively large joints such as knee, shoulder including ankles and wrists. After arthroscopic synovectomy we continued infliximab treatment with MTX in routine manner.

Results: We detected synovium proliferation with vascular increase in patella femoral (PF) joint and around the meniscus and femoral and tibial side of the anterior cruciate ligament (ACL) in the knee joints. We also found synovial proliferation in rotator interval (RI) in the glenohumeral joint and fatty changing in subacromial bursa (SAB) in shoulder. In ankle joint we found synovial proliferation with white meniscoid between tibiofibular joint to develop impingement. Serum CRP was improved from 3.45±0.4 to 1.12±0.2 at 6 weeks, 1.22±0.4 at 50 weeks after arthroscopic synovectomy. There is no severe side effects by arthroscopic synovectomy during infliximab treatment, however 1 patient had slight rash that was improved. DAS28 was improved from 5.58±0.23, to 3.87±0.47 at 6 weeks, improved to 2.58±1.49 at 50 weeks after arthroscopic synovectomy.

Conclusion: It is possible that arthroscopic synovectomy can be one of the effective method to continue infliximab treatment when its efficacy decreased or in non-respond of infliximab for RA patients.