Full knee synovectomy!

RD92

So I’m having a full knee synovectomy in the next few months as the last 10 years I’ve tried every medication, injections and basically anything I can to dampen down the horrible swelling symptoms of arthritis. I’ve been on methotrexate for the past 5/6 years and it’s becoming less and less effective and I’m fed up with living in my 20’s feeling so horrendous when I should be enjoying life! Anyway rant over. Just wondered if anyone knew more info about the synovectomy and what the recovery is like/how long you are immobile. Do you have to wear a cast? Any info would be greatly received! Thanks x

dreamdaisy

Hello, I don't think you're going to like my reply but this is what happened to me.
I have had three synovectomies, two open on my left knee and one closed on my right. The first one, back in 2002, was a big operation as it had to clear five years' worth of liquid and solidified inflammation; my left knee was 27" in circumference and the recovery took months. At this stage no-one medical realised I had an auto-immune inflammatory arthritis and it had to be done again 18 months later because the inflammation returned. When my right knee began to swell my surgeon said a closed synovectomy was required and we went private for that. Needless to say the arthritis continued as these ops did nothing to control disease activity.

Rheumatology grudgingly accepted me as a patient in 2002 but the meds they gave me were far too little and far too late to have any real impact on disease activity. Come 2006 I was finally diagnosed with psoriatic arthritis and since then have been taking methotrexate via sub-cut injection plus anti-TNF medication which eventually brought things under control. Over the years I tried these DMARDs: meth tablets, leflunomide, cyclosporine, sulphasalazine, plus anti-TNF inflximab, enbrel and humira. You mention meth but nothing else - why is this? Has nothing else ever been suggested? The synovectomy will not stop disease activity, it will merely clear the dross out from the joint and one has to hope it will not reoccur: with the right medication it won't. Good luck. DD

stickywicket

I'm sorry you're having such a tough time of things. I, too, started early with my autoimmune arthritis (RA) and it's not easy when all your friends are living the lives we would want for ourselves. Back in the day, there were no DMARDS or biologics on offer so, with only NSAIDS and the occasional course of steroids, OA set in for me fairly quickly and I had two knee replacements 20 years in.

Synovectomy wasn't ever mentioned. I think it's used more for OA and a friend, with knee OA, had a very successful outcome but I'm not sure how useful it is for autoimmune types of arthritis. This is an NCBI report on it. (Just for the record, I think by 'survival' they mean survival of good results not the patient's survival ) https://www.ncbi.nlm.nih.gov/pubmed/27318499

I put the term (synovectomy) into the Versus Arthritis search engine and the result was lots of former threads which might or might not be of use to you. https://arthritiscareforum.org.uk/search.php?keywords=synovectomy&terms=all&author=&sc=1&sf=all&sk=t&sd=d&sr=posts&st=0&ch=300&t=0&submit=Search

Do remember that, even if the operation works well, you'll still have to sort out better meds if methotrexate is becoming less effective. There are plenty of other DMARDS and biologics. I find meth plus hydroxychloroquine very effective. Many people are on triple therapy. I hope you'll find something that helps.

RD92

dreamdaisy wrote:

Thank you for being so honest! Think I’ve just been so unlucky with my rheumatology and consultants I've asked so many times about other medications and always been met with it might not work methotrexate is the best thing. I even tried to ask about what happens when I want a family, to then be told by a nurse that I don’t want to be thinking about that yet I’m too young (26) I’ve ended up paying for a private consultation just because I despair going to my appointments! Still after having this since I was 15 I’m still no closer to a proper diagnosis. They just call it mono. Fed up!

RD92

stickywicket wrote:

Thank you so much for all the information! I think next time I see my consultant I’ll be going with a different attitude! Have asked numerous times about anything else I could have or my other options to just be told methotrexate is the best one. And they still can’t give me a type that they think it is just calling it mono. Well and truly fed up which is why I’ve paid for a private consultation. Just desperation to be off methotrexate. 😩

stickywicket

Monoarthritis is a difficult one to diagnose. It's so-called because it affects just one joint but the cause can be due to various things, some autoimmune and some not. I can understand why your rheumatology team might not want to put you on anything stronger than, or in addition to, methotrexate because the cause might not be autoimmune. I hope a second opinion will help but it might not. Sometimes these things are just not clear cut.

silverfoxxxx

I’m having the same operation on both knees, was told from 2 - 6 weeks away from work. Part of the process for me is to complete the operation whilst my knees are swollen so they can take a biopsy of the inflamed tissue so that a further more accurate diagnosis can be made, same as yourself whatever meds I have makes no difference to the swelling, and apart from the swelling according to my scans my knees aren’t in bad nick.

Fingers crossed this may lead to a better diagnosis for yourself in the long term.

RD92

silverfoxxxx wrote:

Thank you so much!
Did they tell you what you will have to wear on your knee/knees after the synovectomy? Good luck! Hope all goes well for you.

silverfoxxxx

RD92 wrote:

silverfoxxxx wrote:

Thank you so much!
Did they tell you what you will have to wear on your knee/knees after the synovectomy? Good luck! Hope all goes well for you.

No not yet but I’m expecting an update end of this week / early next week as I’ve had flare up so my rheumatology consultant is speaking to the surgeon about getting me in.

stickywicket

My guess is nothing unusual. I've had full knee replacements and all I wore was the dressing over the scar. The key is to rest and exercise.