Early management of the rheumatoid joint.

The success of early management of the inflamed synovial joint in rheumatoid arthritis depends on a team effort. The patient, rheumatologist, orthopaedist, social worker, and physical therapist must communicate with each other and understand the objectives of any treatment program. Present medical therapy is encouraging, but there is still a place for early surgical management. Synovectomy has a definite role, and with careful patient selection using appropriate criteria, satisfactory long-term results may be expected. Future treatment plans will no doubt use medical synovectomy to a greater extent and employ new isotopes, for example, 165Dy. Also, better objective techniques of identifying appropriate candidates with adequate articular cartilage remaining must be developed. No matter which path therapeutic modalities follow, it is necessary to continue developing objective criteria of assessing the long-term results of treatment so that standard methods of reporting follow-up can be used to make appropriate comparisons.