Ann Rehabil Med.  2017 Dec;41(6):998-1004. 10.5535/arm.2017.41.6.998.

Long-Term Efficacy of Rehabilitation Following Arthroscopic Synovectomy in Patients With Rheumatoid Arthritis Treated With Biologic Agents

• Kanbe K
• Sekine C

• KMID: 2400284
• DOI: http://doi.org/10.5535/arm.2017.41.6.998

Abstract

OBJECTIVE
To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents.
METHODS
Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes.
RESULTS
The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89-0.21X).
CONCLUSION
Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.

Keyword

Rehabilitation; Synovectomy; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid*
Biological Factors*
C-Reactive Protein
Humans
Joints
Rehabilitation*
Biological Factors
C-Reactive Protein

Figure

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  Fig. 1 Change in Functional Independence Measure (FIM) after arthroscopic synovectomy with (group 1) or without (group 2) rehabilitation after 9 years.

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  Fig. 2 Health Assessment Questionnaire-Disability Index (HAQ-DI) at 9 years after arthroscopic synovectomy with (group 1) or without (group 2) rehabilitation.

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  Fig. 3 The relationship between Functional Independence Measure (FIM) and Health Assessment Questionnaire-Disability Index (HAQ-DI) after arthroscopic synovectomy.

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  Fig. 4 The relationship between Functional Independence Measure (FIM) after arthroscopic synovectomy and disease duration.

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  Fig. 5 An example of radiographic findings at baseline (A) and at 2 years after arthroscopic synovectomy with rehabilitation (B).

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  Fig. 6 An example of arthroscopic synovectomy. (A) Synovial proliferation (arrow) in the glenohumeral joint of the shoulder. (B) After synovectomy, during which the proliferating synovium was removed using a shaver apparatus.

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