Arthroscopic and radiographic examination of patients with juvenile rheumatoid arthritis before and after open synovectomy of the knee joint. A prospective study with a 5-year follow-up.

In a 5-year follow-up after open knee joint synovectomy in 18 patients with juvenile rheumatoid arthritis (JRA) there was no radiographic progression of the juvenile rheumatoid arthritic changes. Radiographic evidence indicative of osteoarthrosis and of the soft tissue swelling were scored separately. Radiographic changes consistent with osteoarthrosis increased significantly during the observation period (P < 0.001). Arthroscopic evaluation of cartilage changes and radiographic evaluation of osteoarthrosis correlated significantly (P = 0.004). These were the only parameters found predicting the development of further cartilage destruction (P = 0.001). Clinically, the patients had significant improvement five years following synovectomy (P = 0.018), even though three patients required resynovectomy (one successfully after four years, and two patients are waiting for resynovectomy). At the 5-year follow-up both radiographic and clinical data indicate that juvenile rheumatoid arthritic activity of the knee joint was reduced following open synovectomy while osteoarthrosis developed. A new system of scoring radiographic JRA changes of the knee joint was found useful.