Abstract
(Purpose) We reported that the patterns of shoulder joint destruction in RA could be classified into 5groups: Non-progressive(N), Erosive(E), Osteoarthritis-like(O), Collapse(C), and Mutilating(M) types. The natural course of progression and the prognosis differ for each of the 5 types, and can be classified between 5-10 years after the onset of RA. This classification is helpful in planning treatment for a RA shoulder. In this study, the results of arthroscopic synovectomy for rheumatoid shoulder joints were assessed separately for each shoulder joint destruction pattern, and compared.
(Patients and methods) Arthroscopic synovectomy was performed on 15 shoulders of 13 RA patients. The subjects were 10 females and 3 males, the average patients age was 51 years, and the average disease duration was 11.1 years. When these 15 shoulders were classified by pattern of destruction,8 joints were considered E type and 7 joints N type. Among the Japan Orthopedic Association shoulder scoring systems, pain, function and the ROM scoring systems were used for pre-and post-operative estimates. The average duration of follow-up was 9.3 months.
(Results) Overall pre- and post-operative scores were 36.6 and 62.2 in the N group and 39.7 and 49.7 in the E group, respectively. Improvement of the overall score was significantly higher in the N group than in the E group. Pain, function and ROM were improved in both the N and E groups postoperatively, and the improvement of ROM was significantly higher in the N group than in the Egroup.
(Conclusion) We performed arthroscopic synovectomy of the shoulder joint for less destructive types, such as the N and E types. Although the follow-up periods were short, the results were good. Especially, the results of arthroscopic synovectomy for N type shoulders were good, showing improvement of not only pain but also the ROM.
