2007 年 19 巻 1 号 p. 52-55
A 42-year old man with a 13-year history of rheumatoid arthritis (RA) was treated with oral administration of methotorexate and predonisolone, and activity of RA decreased.
From 2003, he was started on anti-TNF-alfa (Infliximab) treatment because of a decreased response to methotrexate and predonisolone. Polyarthralgia decreased after Infliximab administration but arthralgia of bilateral shoulder joints still continued. X-ray findings revealed erosive lesion at both humeral heads and narrowing of the joint space. MRI revealed erosive changes at the humeral head and the glenoid but neither rotator cuff degeneration nor synovitis at the sub acromial bursa were seen.
In 2005 and 2006, the patient underwent arthroscopic synovectomy of left and right shoulder joints, respectively under general anesthesia. Mild inflamed and hyperplastic synovium and fibrous tissue in the shoulder joint were removed as much as possible using a shaver and YAG laser and the joint was irrigated with 5 liters of saline. Arthralgia of shoulder joints was soon reduced, and the range of motion of the shoulder joint was improved to a normal level one to two weeks after the operation. He returned to work one month after the operation.
In early stages of RA shoulder, synovectomy is an effective way to relieve pain and improve the range of motion, and can save time for implant arthoplasty. Arthroscopic surgery has a minimum degree of invasiveness and enables the patient to return to work. However, preoperative existence of the degeneration of articular cartilage or rotator cuff deficiency will worsen the post operative course.