Question: What is a synovectomy and how is it used to treat rheumatoid arthritis?
Answer: Synovectomy is literally the removal of the lining of the joint. The synovium is the lining of the joint and it acts as a filter, mainly to clear debris and potential bacterial or viral infections from involving the joint that we're talking about, and it's a very effective filter. However, in rheumatoid arthritis, the filter becomes clogged with inflammatory debris and inflammatory cells and actually promotes inflammation in and of itself. This lining, which is just a hairpin thick normally, becomes very thickened and swollen and really is a mass of inflammatory cells producing all kinds of inflammatory chemicals that injure the cartilage and the bone in the joint. Sometimes, the inflammatory mass of the synovium becomes so recalcitrant to treatment that the lining is removed surgically.
There are several methods by which it could be removed. Traditionally, it was done with an open-knee operation, but that's been long abandoned now that we have arthroscopy. There are chemical ways of removing it by injecting certain medications, either radioactive or other chemicals that remove the lining of the joint, however these are mainly research-based and not available to the public. So arthroscopic removal of the synovium or synovectomy is the method that's done and, fortunately, now the medicines are so much better than in the past, this is becoming a much less common procedure.