S36 HO-YAG LASER TREATMENT IN SHOULDER ARTHROSCOPIC SYNOVECTOMY OF RHEUMATOID ARTHRITIS

Abstract

Purpose: Synovium proliferation of rheumatoid arthritis (RA) is a key role in development of destruction in articular joints. Arthroscopic synovectomy is quite useful for resection synovium less invasively for RA patients. However there are few papers about shoulder joint synovectomy of rheumatoid arthritis. Ho-YAG laser is also effective to decrease synovium proliferation. The advantage of using Ho-YAG laser is effective to pannus even in deep zone of bone erosion. In this paper, we treated 13 shoulders of 11 patients of RA by using Ho-YAG laser to assess whether Ho-YAGH laser is effective in shoulder arthroscopic synovectomy of RA

Materials and Methods: We treated 13 shoulders in 11 patients of RA, including 8 in stage II, 4 in stage III, 1 in stage IV. The duration of RA is an average of 4, 6 years. The follow-up period is an average of 14 months. We compared CRP, DAS28 and MRI findings before and after surgery. Those patients were taking DMARDs such as MTX in 8 patients, steroid in 3 patients infliximab in 1 patient and etanercept in 1 patient. We used 4.0 mm arthroscope, VAPR and shaver for synovectomy. Ho-YAG laser set to 10W to bone erosion area to reach deep zone of pannus and to resect synovium.

Results: We found villous synovium proliferation with vascularity in rotator interval and supraspinatus tendon in shoulder joint. In subacromial bursa, yellow fat tissue and white fibrous soft tissue was detected almost all shoulders. After synovectomy by using Ho-YAG laser, CRP was decreased from an average of 3.6 to 0.8 and DAS28 was also decreased an average of 5.4 to 3.7 at 14 month after surgery. MRI showed decreased pannus with synovium and joint destruction was not preceding after 14 month.

Discussion: Ho-YAG laser is effective for using shoulder arthroscopic synovectomy especially to treat pannus in bone erosion. The amount of energy of Ho-YAG laser for synovectomy is not clear so far. We used 10W for 5 second in each area that could be effective to decrease pannus formation. We would further investigate in the basic experimental levels to confirm Ho-YAG laser efficacy.