ARTHROSCOPIC CONTRA OPEN ARTICULOSYNOVECT OMY OF THE KNEE IN RHEUMATOID-ARTHRITIS - IS THERE A DIFFERENCE IN A POSSIBLE SYSTEMIC EFFECT

Up to now no prospective study has been published comparing a possible influence exercised by arthroscopic and open articulosynovectomy of t he knee, on the general course of disease in patients with underlying inflammatory disease. Therefore, this study was performed to evaluate and compare suspected systemic effects of articulosynovectomy of the k nee via an open (group 1) or arthroscopic (group 2) approach. Twelve p atients (4 male and 8 female, 28-71 years of age), all of whom had rhe umatoid arthritis (ARA criteria from 1988), underwent therapy for arti culo-synovitis of the knee joint in one of the above named groups. Med ical management was standardised for all patients: methotrexate i. m. or i. v. once weekly, prednisolone < 7,5 mg daily, diclofenac < 150 mg daily. During the follow-up period patients were examined for pain, s ynovial swelling, radiological stage of joint destruction (Larsen-Dale -Eek) and blood tests for erythrocyte sedimentation rate (ESR) accordi ng to Westergren, C-reactive protein (CRP) and rheumatoid factor (RF). The results showed that articulosynovectomy performed via the arthros copic or open approach reduced the total inflammatory activity, demons trated by reduction of ESR, CRP and RF levels. There was no significan t difference between the results of both treatment regimes. Because of easier postoperative rehabilitation, we favour arthroscopic synovecto my to open surgery if there is no additional pathology of the joint.