Internal Medicine

Chemosynoviorthesis

Synonyms in a broader sense

chemical destruction of the joint lining (synovitis)

introduction

The chronic polyarthritis (Rheumatism) is a chronic inflammatory joint disease that requires interdisciplinary treatment. The first point of contact is the rheumatological specialist Orthopedist and Internist. Rheumatic treatment consists of medication, physiotherapy, Occupational therapy, physical therapy and possibly also through operations. While the classic Medication affect the entire organism, it is possible Joints specifically treated by injections. A major problem with the chronic polyarthritis (rheumatism) are recurring painful joint inflammations. In these acute phases of a rheumatic event, they swell Joint mucous membranes inflammatory and lead to permanent joint damage if the disease lasts for a long time.

Chemical synoviorthesis

One therapeutic approach for rheumatoid arthritis is therefore the elimination of the destructive and chronic inflammatory Synovial membrane. In addition to the surgical removal of the mucous membrane, there is the option of obliterating the mucous membrane by injecting chemical or radioactive substances (Chemosynoviorthesis or Radiosynoviorthesis).
Chemical substances such as Sodium Morrhuate (Scleromate®) attack the inflamed synovial membrane directly and lead to the destruction of the mucous membrane. The dead tissue is absorbed and excreted by the body. A chemical synoviorthesis sometimes has to be done several times to achieve the desired success. An already existing articular cartilage damage (arthrosis) can no longer be undone.

Chances of success

A chemosynoviorthesis often leads to long-lasting improvements in joint swelling, pain and joint function. The chances of success are worse if there is already advanced damage to the joint being treated. Frequently used and promising - especially on large joints (e.g. knee joint) - is the combination therapy of surgical removal of the mucous membrane and subsequent chemosynoviorthesis, which removes mucous membrane residues that always remain after surgical removal of the mucous membrane.

execution

The treated joint is carefully cleaned with an alcoholic disinfectant solution. The joint puncture is performed under sterile conditions. First a possibly existing Joint effusion peeled off, then injected a local anesthetic. Then the sclerosing agent in exactly the correct dosage injected.
In the subsequent period, there may be a temporary worsening of the findings (redness, swelling, pain) of the joint, caused by an accompanying inflammation and the breakdown products of the synovial membrane.
As a rule, there is no damaging effect on the joint cartilage. In order for the medication to work optimally, it is important to keep calm after initially moving the joint.

side effect

Serious side effects are rare.
The most dangerous thing is the spread of skin germs inside the joint. It is therefore essential to maintain sterile working conditions. In extremely rare cases, swelling of the soft tissue in the area around the treated joint can cause a thrombosis to be triggered.
General effects on the organism can be short-term fever and chills be, as well as an increase of white blood cells and the Liver values. In addition to the aforementioned reactions in the joint, an accidental injection of medication into the soft tissues can lead to pain and local inflammation, which almost always has no consequences.

Contraindication

Pregnant women and patients with existing liver and / or kidney disease are excluded from treatment using chemical synoviorthesis.

Aftercare

The treated joint should be spared for a period of 48 hours. For joints of the lower extremities, this means relieving the leg and mobilizing the patient on two forearm crutches or in a wheelchair.
Thereafter, treatment can be continued with a symptom-dependent build-up of stress up to rapid full stress. A subsequent exercise therapy is intended to prevent joint stiffening caused by a drug-induced capsule shrinkage could be caused. Local complaints such as: