Synonyms in a broader sense
chemical destruction of the joint mucosa (synovitis)
Introduction
Chronic polyarthritis (rheumatism) is a chronic inflammatory joint disease that requires interdisciplinary treatment. The first point of contact is the rheumatology specialist orthopaedist and internist. Rheumatic treatment consists of medication, physiotherapy, ergotherapy, physical therapy and, if necessary, surgery.
While the classical medicines influence the entire organism, it is possible to treat joints specifically by injections. One of the main problems with chronic polyarthritis (rheumatism) is recurrent painful joint inflammation. In these acute phases of a rheumatic event, the joint mucous membranes swell up in an inflammatory manner and, if the disease lasts for a long time, lead to permanent joint damage.
Chemical Synoviorthesis
One approach to therapy in chronic polyarthritis is therefore the removal of the destructive and chronically inflammatory joint mucosa. In addition to surgical removal of the mucosa, there is also the possibility of sclerosing the mucosa by injection of chemical or radioactive substances (chemosynoviorthesis or radiosynoviorthesis). Chemical substances such as sodium morrhuates (Scleromate®) directly attack the inflamed joint mucosa and lead to the destruction of the mucosa.
The dead tissue is absorbed and excreted by the body. A chemical synoviorthesis sometimes has to be performed several times to achieve the desired success. However, an already existing joint cartilage damage (arthrosis) cannot be reversed.
Prospects of success
Chemosynoviorthesis often leads to long-term improvements in joint swelling, pain and joint function. The chances of success are worse if there is already advanced damage to the treated joint. Frequently used and promising – especially in large joints (e.g. knee joint) – is the combination therapy of surgical removal of the mucosa and subsequent chemosynoviorthesis, which removes any remaining mucosa that always remains after surgical removal of the mucosa.
The treated joint is carefully cleaned with alcoholic disinfectant solution. The joint puncture is performed under sterile conditions. First, any joint effusion is removed, then a local anaesthetic is injected.
Then the sclerosing agent is injected in exactly the right dosage. Subsequently, a temporary deterioration of the joint findings (redness, swelling, pain) may occur, caused by accompanying inflammation and the degradation products of the joint mucosa. There is usually no damaging effect on the joint cartilage. In order for the drug to have an optimal effect, it is important to keep still after initially moving the joint.
Side effect
Serious side effects are rare. Most dangerous is the carry-over of skin germs into the inside of the joint. It is therefore essential to maintain sterile working conditions.
In extremely rare cases, a soft tissue swelling in the vicinity of the treated joint can trigger a thrombosis. General effects on the organism can be short-term fever and chills, as well as an increase in white blood cells and liver values. In addition to the above-mentioned reactions in the joint, an accidental injection of medication into the soft tissues can lead to pain and local inflammation, which almost always remains without consequences.
