It is possible to perform both prophylactic (preventive) and reconstructive (restorative) surgery:
- Synovectomy: A synovectomy involves the complete removal of the diseased synovium of a joint (articulosynovectomy) or the tendon sheaths (tenosynovectomy). The operation can be performed in the early stages of the disease to delay the destruction of the joint, but also in the late stages to relieve painful symptoms.
- Arthrodesis: Another surgical therapy option is an arthrodesis. Here, an artificial stiffening of a joint with the aim of enabling a pain-free load of the same. Is considered the gold standard in advanced destructed (“destroyed”) wrist.
- Joint replacement: in the case of joint destruction and painful functional limitation, there is an indication for joint replacement as ultima ratio.
Non-surgical therapeutic measure
Radiosynoviorthesis (RSO, from radioactive isotope, synovial joint lining, orthotic restoration; RSO for short) is one of the nuclear medicine procedures used therapeutically in rheumatology and orthopedics for the treatment of rheumatoid arthritis. The application of radiosynoviorthesis provides the possibility of reconstruction of the synovium (inner lining of the joint cavity without cell contacts). The reconstruction of the synovium is based on the use of beta-emitters (radionucleotides). The beta rays significantly reduce local hyperemia (increased blood supply) and induce inactivation of existing inflammatory cells. Furthermore, the destructive (devastating) effect of the beta rays causes a connective tissue transformation of the synovium (synovial membrane). This can last up to 3 months. To avoid additional infection, the injection of the radioactive substance is performed under strictly aseptic conditions and X-ray fluoroscopy. Parallel to the radioactive substance, a steroid (inflammation inhibitor) can also be applied.
If treatment is given at a later stage, the chances of success are significantly reduced.
