Efficacy of holmium. Yttrium-aluminium-garnet (Ho: YAG) laser therapy for arthroscopic synovectomy of rheumatoid arthritis

To clarify the efficacy of holmium: yttrium-aluminium-garnet (Ho: YAG) laser therapy for arthroscopic synovectomy of rheumatoid arthritis (RA), we treated 13 shoulders of 11 RA patients of whom 1 was stage I, 7 stage II, 2 stage III, and 1 stage IV. The duration of RA is 4.6 years on average and the follow-up period is an average of 14 months. The Ho: YAG laser was set at 10 Watt (W) to treat the bone erosion areas so as to reach the deep zones of the pannus in order to resect the synovium. We compared C-reactive protein (CRP), Disease activity score (DAS) 28 and magnetic resonance image (MRI) findings before and after surgery. We cultured primary synovial cells to assay cytokine production of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α. Morphological examination was performed after treatment with the Ho: YAG laser at 0, 1, 5, 10, 15 and 20 W. We found villous synovium proliferation with vascularity in the rotator interval and supra spinatus tendon in the shoulder joints. In the subacromial bursa, yellow fat tissue and white fibrous soft tissue were detected in almost all shoulders. After synovectomy using the Ho: YAG laser, CRP decreased from an average of 3.6 to 0.8 and DAS28 also decreased from an average of 5.4 to 3.7 at 14 months after surgery. MRI showed decreased panni with synovium and did not precede joint destruction after 14 months in 10 shoulders out of 13 (77%). At 20 W of the Ho: YAG laser treatment, the synovial cells shrank as in apoptosis and the number of cells also decreased. Laser treatment also resulted in the following significant changes: TNF-α production increased at 1, 10, 15 and 20 W (compared with 0 W) but not dose dependently; IL-1β and IL-6 increased up to 10 W (compared with 0 W) but decreased at 15 and 20 W (compared with 10 W). In morphological examination, after treatment with the Ho: YAG laser at 15 W, the synovial cells expanded and the number of cells decreased. Therefore, Ho: YAG laser therapy is effective for arthroscopic synovectomy, especially in treating pannus in bone erosion. We used 10 W for 5 seconds in each area where it could effectively decrease pannus formation. (author)