To investigate the clinical effect of arthroscopic synovectomy in the treatment of refractory rheumatoid arthritis (RA).

The clinical data of 108 patients with refractory RA who were treated at the Huishan Second People′s Hospital and the Wuxi Fifth People′s Hospital of from January 2017 to December 2020 with complete clinical data were retrospectively selected, and they were divided into the observation group (54 cases) and the control group (54 cases) according to the different treatment methods. The control group was treated with anti-rheumatic drugs (methotrexate+ leflunomide tablets) for six months, while the observation group was treated with arthroscopic synovectomy and anti-rheumatic drugs for six months after operation. The excellent and good rate of joint function after six months, serum levels of helper T cells 1 (Th1), regulatory T cells (Tregs), clinical symptom score and morning stiffness time before and after six months were observed. Chi-square test or t test was used for data analyses.

After six months of treatment, the excellent and good rate of joint function in the observation group was 83%, which was higher than 63% in the control group ( χ²=5.704, P<0.05). After six months of treatment, the levels of serum tumor necrosis factor α (TNF-α), interferon-γ (IFN-γ), interleukin-2 (IL-2) and the percentage of Th1 cell subsets in the two groups were lower than those before the treatment, and the data in the observation group were lower than the control group (t=2.057, 2.734, 2.372, 2.360, all P<0.05). The percentages of cluster differentiation(CD)4⁺ CD25⁺ cells, CD4⁺ CD25⁺ CD127⁺ cells and Tregs cell subsets were higher than before treatment, and the data in the observation group were higher than the control group (t=2.792, 5.443, 2.432, all P<0.05). After six months of treatment, the joint swelling, joint tenderness and joint pain scores in the two groups were lower than those before treatment, while those in the observation group were lower than those in the control group (t=2.669, 4.900, 3.545, all P<0.05). The morning stiffness time was shorter than before treatment, and the observation group was shorter than the control group (t=4.210, P<0.05).

Arthroscopic synovectomy could adjust the expression level of Th1 and Treg cells in the patients with refractory RA, promote the improvement of their clinical symptoms, and may have significant effect.