NONSURGICAL SYNOVECTOMY

When chronic, non-infectious, inflammatory mono-articular or pauciarti cular synovitis is unresponsive to medical treatment, surgical synovec tomy is often indicated. Unfortunately, surgery carries with it the ex pense and inconvenience of hospitalization and rehabilitation and the inherent risk of infection, and it leaves an unsightly scar. Intra-art icular 'chemical synovectomy' obviates the need for hospitalization an d prolonged rehabilitation and has been used as alternative therapy. T he most extensively used agents are corticosteroid derivatives. When t hese fail, certain chemical agents, chemotherapeutic drugs and radio-i sotopes have been employed. Most series describe the use of these agen ts in rheumatoid arthritis or other inflammatory arthritides. The exce ption is orgotein, a copper-zinc superoxide dismutase, which in compar ative trials with both placebo (McIlwain et al, 1989) and corticostero ids (Gammer and Broback, 1984; Mazieres et al, 1991) demonstrated bene fit in some patients with osteoarthritis. We will confine the focus of this critical review to the use of non-surgical synovectomy in inflam matory arthritides.