Background The aim of this study is to investigate the effect of arthroscopic synovectomy (AS) on disease status in patients with rheumatoid arthritis (RA). Methods A prospective study was conducted among patients with RA who underwent AS of the elbow or knee joints due to persistent swelling following conventional treatment, as well as control individuals who only received conventional treatment. All patients were evaluated at baseline and 4, 12, 24, 48, 96 weeks after AS. The coprimary outcomes were week 96 disease activity score (DAS)-28 remission and American College of Rheumatology improvement criteria (ACR20/50/70) remission. Key secondary outcomes were changes from baseline to week 96 in Mayo score, Lysoholm score, Health Assessment questionnaire (HAQ), patient’s visual analogue scale, Magnetic Resonance Imaging in AS group. The correlation between synovial tissue biology and clinical response was analyzed. Results A total of 51 patients were included, with 17 accepted AS and conventional treatment, 34 only accepted conventional treatment. At week 96, more patients in AS group achieved DAS-28 remission [52.9% (9/17) vs 11.8% (4/34), P = 0.005] and ACR70 response [35.3% (6/11) vs 5.9% (2/34), P = 0.021] compared with control group. In AS group, DAS28 score [3.9 (3.7, 4.4) vs 2.8 (2.2, 3.4), P = 0.0002], MAYO score [52.5, (45.3, 62.8) vs 72 (60. 76.3), P = 0.021], Lysoholm score [55.5 (50, 59.5) vs 67.5 (63, 78), P = 0.020] and HAQ [4 (1, 6) vs 1 (0, 2), P = 0.034] improved significantly at week 4, 4, 12 and 48 respectively, and persisted until week 96. An increase in disease activity after AS was exclusively noted in the diffuse myeloid group. Conclusion The disease activity and joint function of RA patients who underwent AS showed considerable improvement after surgery, which suggests that AS may enhance the likelihood of achieving remission in patients who had been treated with multiple DMARDs but have not achieved remission. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec colname="c1" colnum="1" /> <colspec colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • The rate of patients achieved disease remission in AS group at week 96 endpoint was better than that of the conventional treatment group. • Patients with RA after AS showed sustained improvement in disease activity and joint function, which remained stable for 96 weeks. • Only patients with diffuse myeloid synovial pathology exhibit increased disease activity. </entry> </row> </tbody> </tgroup> </Table>

The value of arthroscopic synovectomy in the treatment of rheumatoid arthritis: A prospective cohort study

期刊论文
发表日期：

2026年6月28日

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Li-yi Dai,
Jia-qi Ren,
Yu-qing Zhao,
Jin-xia Zhao,
Rong Mu,
Yu-ping Yang

摘要

Background

The aim of this study is to investigate the effect of arthroscopic synovectomy (AS) on disease status in patients with rheumatoid arthritis (RA).

Methods

A prospective study was conducted among patients with RA who underwent AS of the elbow or knee joints due to persistent swelling following conventional treatment, as well as control individuals who only received conventional treatment. All patients were evaluated at baseline and 4, 12, 24, 48, 96 weeks after AS. The coprimary outcomes were week 96 disease activity score (DAS)-28 remission and American College of Rheumatology improvement criteria (ACR20/50/70) remission. Key secondary outcomes were changes from baseline to week 96 in Mayo score, Lysoholm score, Health Assessment questionnaire (HAQ), patient’s visual analogue scale, Magnetic Resonance Imaging in AS group. The correlation between synovial tissue biology and clinical response was analyzed.

Results

A total of 51 patients were included, with 17 accepted AS and conventional treatment, 34 only accepted conventional treatment. At week 96, more patients in AS group achieved DAS-28 remission [52.9% (9/17) vs 11.8% (4/34), P = 0.005] and ACR70 response [35.3% (6/11) vs 5.9% (2/34), P = 0.021] compared with control group. In AS group, DAS28 score [3.9 (3.7, 4.4) vs 2.8 (2.2, 3.4), P = 0.0002], MAYO score [52.5, (45.3, 62.8) vs 72 (60. 76.3), P = 0.021], Lysoholm score [55.5 (50, 59.5) vs 67.5 (63, 78), P = 0.020] and HAQ [4 (1, 6) vs 1 (0, 2), P = 0.034] improved significantly at week 4, 4, 12 and 48 respectively, and persisted until week 96. An increase in disease activity after AS was exclusively noted in the diffuse myeloid group.

Conclusion

The disease activity and joint function of RA patients who underwent AS showed considerable improvement after surgery, which suggests that AS may enhance the likelihood of achieving remission in patients who had been treated with multiple DMARDs but have not achieved remission.

Key Points

• The rate of patients achieved disease remission in AS group at week 96 endpoint was better than that of the conventional treatment group.

• Patients with RA after AS showed sustained improvement in disease activity and joint function, which remained stable for 96 weeks.

• Only patients with diffuse myeloid synovial pathology exhibit increased disease activity.