Re: Radical Multiple Synovectomy More Effective thanDisease-Modifying Drugs for Rheumatoid Arthritis In Short But Not LongTerm

[Guest guest]

Another very interesting one, a, although I don't understand why

they thought it might be a cure. Prolonged relief - yes, I can buy that.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] Radical Multiple Synovectomy More Effective

thanDisease-Modifying Drugs for Rheumatoid Arthritis In Short But Not

LongTerm

> Radical Multiple Synovectomy More Effective than Disease-Modifying

Drugs for

> Rheumatoid Arthritis In Short But Not Long Term

>

>

> 04/30/2004

> By Jillian Lokere

>

>

> Radical multiple synovectomy seems to promote a rapid remission of

> rheumatoid arthritis, but after 5 years, it is no more effective than

is

> combination therapy with disease disease-modifying anti-rheumatic

drugs

> (DMARDs).

>

> Synovectomy reduces rheumatoid arthritis (RA) disease activity by

removing

> joint synovial tissue that has become inflamed. A study in the 1980s

by

> MacEwen and colleagues found that traditional synovectomy of the

finger or

> knee joints had no long-term impact on disease progression. In this

study,

> Hiroshi Nakamura, MD, PhD, of the Institute of Medical Science, St.

nn

> University, Kanagawa, Japan, and colleagues evaluated the long-term

impact

> on RA progression of a new synovectomy procedure they developed,

called

> radical multiple synovectomy (RaMS).

>

> Forty-two patients whose disease was unresponsive to DMARDs for at

least 6

> months were given RaMS and followed for an average of 7.3 years.

Fourteen

> patients who began and were responsive to triple DMARD therapy

> (methotrexate, salazosulfapyridine, and bucillamine) during the same

time

> period were selected from patient records as controls. Before RaMS or

start

> of triple DMARD therapy, the following medications were given:

prednisolone

> 4.1 to 4.7 mg daily (93% of RaMS, 93% of control); methotrexate 2.5 mg

to

> 7.5 mg weekly (76% of RaMS, 50% of control); other DMARD (56% of RaMS,

35%

> of control) and double DMARD therapy (35% of RaMS, 7% of control).

>

> The RaMS procedure involved open synovectomy of an average of 11.1

joints

> per patient. After surgery, prednisolone was continued unchanged while

DMARD

> dosages were increased in the RaMS group. In the control group, all

patients

> were taking prednisolone along with the triple DMARD regimen.

>

> Remission was classified as lack of arthritic symptoms or fatigue,

> regardless of erythrocyte sedimentation rate (ESR) and serum

C-reactive

> protein levels (CRP). Three months after RaMS or start of triple DMARD

> therapy, 69% of patients in the surgery group, but none of the

controls,

> achieved remission (P<] < .05). After 36 months, 55% of RaMS patients

were

> still in remission compared with only 10% of controls ([P<] < .05).

However,

> after 5 years, both groups showed a similar remission rate of 30%.

> Improvement in the number of swollen joints, number of painful joints,

ESR,

> CRP levels, rheumatoid factor levels and grip strength came more

rapidly in

> the RaMS group than in the control group, but only CRP levels and

number of

> painful joints were significantly different 7 years post-treatment.

" The

> effects of RaMS as measured by the clinical and laboratory findings

appeared

> very quickly and were superior to the controls in a short-term

follow-up,

> without any adverse events, " conclude Dr. Nakamura and colleagues.

" Although

> it was hoped that our [RaMS] procedure might offer a radical cure of

RA,

> RaMS was unable to alter the natural course of the disease.

> Clin Exp Rheumatol 2004;22:1515-157

[Guest guest]

Since the cause of RA really isn¹t know, I guess the prolonged relief was an

indication that it was a cure.

Since RA is systemic, I¹m also surprised that they thought it could be a

possible cure.

I had multiple synovectomies which brought years of relief, leading me to

believe it was a cure.

It decreased the swelling and pain in the joint, but the bone erosion was

still going on.

a

> Another very interesting one, a, although I don't understand why

> they thought it might be a cure. Prolonged relief - yes, I can buy that.

>