What is the chemosynovi orthosis?A chemosynoviorthesis is a therapy for rheumatic or arthritic joint diseases such as chronic polyarthritis (including rheumatism). For this purpose, a chemical drug is introduced into the affected joint by injection
A chemosynoviorthesis is a therapy for rheumatic or arthritic joint diseases such as chronic polyarthritis (including rheumatism). For this purpose, a chemical drug (including osmic acid, Natriummorrhuat) is injected into the affected joint in order to destroy the pathologically altered synovium.
By sclerosing the synovial membrane, a renewal and reconstruction of the affected synovial membrane is stimulated. The treatment procedure often leads to a long-term improvement of swelling, pain and the function of the treated joint.
Especially with larger joints (including knee joint), a chemosynoviorthesis is often performed following a surgical removal of the synovial membrane (synovectomy) in order to slough off the remaining synovialis in the joint.
Function, effect & goals
Chemosynoviorthesis is mainly used in recurrent or chronic inflammations of the synovial membrane (including chronic polyarthritis, rheumatoid arthritis), which are associated with painful joint swelling.
In particular, in monarthritic processes in which a single joint is affected, using a chemosynoviorthesis is attempted to turn off the soil or the pathologically altered tissue structures on which the arthritides can develop locally by a chemical drug, followed by a healthy synovium in the affected joint can develop. Chemosynoviorthesis may also be indicated if an indication for joint surgery or synovectomy is not given or other surgical procedures are contraindicated.
Likewise, a chemosynoviorthesis in the presence of active mono- or oligoarthritis (a few joints are affected) and chronic polyarthritis with synovitis (joint inflammation) of individual, especially smaller joints are used. Chemically induced sclerotherapy may also be indicated in recurrent synovitis due to surgical synovectomy. In the run-up to chemosynoviorthesis, an X-ray of the joint to be treated should be taken in order to exclude pronounced signs of destruction, exposed joint bodies and aseptic bone necrosis.
In addition, using a sonogram (ultrasound image), articular effusions were localized and differentiated from proliferating (proliferating) tissue structures. Following the disinfecting measures, any articular effusions present are first punctured. Thereafter, to exclude peri-articular injection, a diagnostic injection should be made with a local anesthetic (including Scandicain) before the decaying drug is injected intra-articularly.
The most common substances used in chemosynoviorthesis are osmic acid and sodium morrhuate. Osmic acid is absorbed by the synovial cells and causes coagulation necrosis in the treated tissue structures. Sodium morrhuate, after intra-articular injection via cell membrane damage, causes cytolysis (cell dissolution), which is locally associated with a massive inflammatory response as well as synovial membrane necrosis.
In addition, immunocompetent tissue structures such as pathologically altered T cells, which are responsible for rheumatic inflammation, among others, are destroyed by the inflammatory reaction. For the 48 hours following the chemosynoviorthesis, the affected joint should be immobilized and sufficiently cooled (eg with ice packs). In some cases, chemosynoviorthesis is repeated one or more times.
Risks, side effects & dangers
Common side effects following chemosynoviorthesis include swelling, redness and pain in the affected joint (deterioration of findings), which are induced by the degradation of the decayed mucous membranes and corresponding inflammatory processes and symptomatic therapy (eg cooling, anti-inflammatory and analgesic medications ) be treated.
Serious side effects or complications are rarely seen with chemosynoviorthesis. However, carry-over of pathogens into the interior of the joint can have dangerous consequences. In very rare cases, swelling of soft tissue near the treated joint, which can lead to thrombosis, can be detected. Systemically, ie in relation to the entire human organism, it can temporarily lead to fever and increased liver and blood cell values.
In addition, inadvertent injection of the decaying drugs into soft tissue structures can cause pain and localized inflammation, which, however, usually remain without consequences. Chemosynoviorthesis is also contraindicated in the presence of pregnancy, liver and / or renal failure. On the patient side, careful follow-up of physiotherapy and symptom-dependent stress build-up must be ensured in order to avoid medication-induced capsular shrinkage after chemosynoviorthesis. Damage to the articular cartilage can usually be excluded in a chemosynoviorthesis.