"Dr. Zhao, I saw your popular science article, saying that synovial inflammation is the main feature of rheumatoid, synovial hyperplasia leads to the destruction of joint structure, is the synovium important, can the synovium be removed to treat rheumatoid arthritis?"
It is true that synovectomy is one of the commonly used treatments for rheumatoid arthritis, but is it not necessary to cut the synovium to solve the pain and deformity threat of rheumatoid arthritis patients? Let's take a look!
<h1 class="pgc-h-arrow-right" > how is rheumatoid arthritis related to synovial membranes? </h1>
Rheumatoid arthritis is an autoimmune disease that predominantly invades synovial joints, but not only joints.
Synovial joints, as the name suggests, are joints with synovial tissue, that is, movable joints. Synovial joints have a pronounced joint cavity, the wall of the cavity has a synovium, and the synovial fluid secreted by the synovium plays an important role in nourishing and lubricating the joints.
Rheumatoid arthritis because of immune disorders, immune cells attack the original normal synovial tissue, resulting in synovial cells inflamed, synovial cells can not be normal apoptosis, continuous proliferation, inflammation persists. The synovial membrane is in a state of inflammation and hyperplasia for a long time, and the hyperplasia will form a villous protrusion - a vascular filament, which can protrude into the joint cavity and invade the bone under the cartilage and cartilage, resulting in the destruction of the joint structure, and eventually leading to joint deformity or loss of function.
Therefore, synovial inflammation and hyperplasia are the direct "murderers" of rheumatoid joint destruction.
How does synovectomy > <h1 class="pgc-h-arrow-right" help rheumatoid patients? </h1>
Synovectomy is of great help to some patients with rheumatoid arthritis.
Synovectomy has long been used in the treatment of rheumatoid arthritis, and by removing the synovium, it can help rheumatoid patients in many ways:
(1) Excision of hypertrophic synovial membrane can reduce the pressure in the joint cavity and remove the nerve endings on the synovium, which can reduce the pain of the joint.
(2) After removing most of the synovial hyperproliferative tissue that releases inflammatory mediators and causes joint effusion, the vicious cycle of inflammation can be interrupted and further destruction of joint cartilage and bone can be prevented.
(3) Removal of the extremely hyperplastic synovium can eliminate the joint dysfunction caused by the proliferating synovium and reduce the patient's obsessive-compulsive position.
(4) The hypertrophic synovial tissue, osteophytes and destroyed meniscus are removed, which helps the patient to increase the mobility of the knee joint and prevents further flexion contracture of the knee joint.
(5) After synovial resection, the soft tissue around the joint is preserved, and the patient can also obtain a stable knee joint.
In general, synovectomy can achieve two purposes, one is to reduce or eliminate joint pain, and the other is to maximize the recovery of joint function. However, to obtain a good treatment effect, it is necessary to meet the indications, and not all rheumatoid patients need to use synovectomy.
< h1 class="pgc-h-arrow-right" > can patients undergo early synovectomy? </h1>
Some patients, seeing that the effect of synovectomy is so good, should it be removed early and relieved of the disease as soon as possible? Some patients have severely damaged their joint structures, can they be "flipped" by synovectomy?
The application of synovectomy requires two conditions: one is that, as with other surgeries, the activity of the disease requires some degree of inhibition, and the other is that the vascular fins of synovial hyperplasia have not yet invaded under the cartilage. The first point is easy to understand, patients with high disease activity can not undergo surgery, until the disease is relieved, but what is the second point?
In fact, synovectomy is indicated in patients who are still in the early stages of the disease, although there is significant joint swelling and synovial hypertrophy, but the joint space below the X-ray line has not disappeared or there is no obvious stenosis. If synovial hyperplasia has caused damage to the cartilage and subchondral bone, even if the hyperplastic synovium is removed, the recurrence of inflammation and joint destruction will continue to develop, and the treatment is of little significance.
Therefore, synovectomy does not have the ability to "bring the joint back to life" and does not help all patients completely solve rheumatoid. Before considering treatment, there are several indications to master:
After 6 months of regular treatment of traditional Chinese and Western medicine, the effect is not obvious;
Persistent pain in the joints;
Intermittent or persistent swelling of the joints;
Examination of palpable hypertrophic synovium;
Appearance of mild flexion deformities of the joints;
X-rays show early signs of erosion of the joint bone.
If the above 1 is met, synovectomy can be considered, but whether it should be operated or not should be comprehensively judged according to the degree of motion of rheumatoid disease, the feedback of drug treatment effect, and the degree of joint lesions diagnosed by imaging.
In the past, synovectomy using open resection, now more use arthroscopic visits to the synaptic membrane resection, this method has a small wound, postoperative recovery and other characteristics, for synovial hyperplasia and hypertrophy is not particularly serious patients, priority to take this approach, especially suitable for knee, elbow, shoulder and other large joint treatment, not easy to damage meniscus and other tissues.
Synovectomy may still regenerate, so synovectomy has a certain recurrence rate of 5.7% to 67%, but the regenerated synovium is significantly reduced compared with the synovium before resection, and the activity of pathological enzymes and immunoactive substances is significantly reduced, less violation of the joint cartilage surface, and rarely reaches the degree of need to re-remove the synovium.
Synovectomy has the advantage of treatment, but it is not that rheumatoid patients must be used, due to the development of drugs, the early combination of the use of anti-rheumatic drugs with a strong effect to improve the condition, inhibit the inflammation of the synovium, most patients have no need for surgery to remove the synovium, and the number of synovectomy is also decreasing. However, synovectomy remains an effective option for patients with complications, initial absence of medication, or poor efficacy of medication.