【Abstract】 Objective To explore the effectiveness of multiple joint arthroplasty in treating lower limb joint disease. Methods Between January 2000 and December 2007, 5 patients with lower limb joint disease (three or more joints were involved) were treated with total hip and knee arthroplasty. There were 3 males and 2 females, aged from 27 to 59 years (mean, 41.8 years). Two patients had ankylosing spondylitis and 3 had rheumatoid arthritis, whose hip and knee joints were involved. Four patients lost the ability of walking preoperatively, 1 patient could only walk with crutch. The Harris score was 24 ± 24 and the Hospital for Special Surgery (HSS) score was 28 ± 15. All patients underwent multiple joint arthroplasty simultaneously (2 cases) or multiple-stage (3 cases). Results Wounds healed by first intention in all patients. In 1 patient who had dislocation of the hip after operation, manipulative reduction and immobilization with skin traction were given for 3 weeks, and no dislocation occurred; in 2 patients who had early sign of anemia, blood transfusion was given. All patients were followed up 46-140 months with an average of 75 months. The patients could walk normally, and had no difficulty in upstairs and downstairs. The stability of the hip and knee was good, and no joint infection or loosening occurred. The Harris score was 88 ± 6 at last follow-up, showing significant difference when compared with the preoperative score (t=8.16, P=0.00); the HSS score was 86 ± 6, showing significant difference when compared with the preoperative score (t=13.96, P=0.00). Conclusion Multiple joint arthroplasty is an effective treatment method in patients with lower limb joint disease, which can significantly improve life quality of patients.
Objective To evaluate the efficacy and safety of adalimumab for rheumatoid arthritis failing to respond to disease-modifying anti-rheumatic drugs (DMARDs). Methods The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and Wanfang (from the date of their establishments to June 2010) were searched, and journals of relevant fields were retrieved to identify randomized controlled trials (RCTs). The data were analyzed by using RevMan 5.0 software. Results Four RCTs were included, all of which were from abroad and with good methodological quality. The baseline data of each trial were comparable. Meta-analyses showed that there was a significant difference between the adalimumab and the placebo in terms of ACR20, ACR50, ACR70, tender joint count, swollen joint count, patient assessment of pain, patient global assessment of disease activity, doctor global assessment of disease activity, and disability index of the HAQ. There was no difference between the adalimumab and the placebo in terms of serious adverse events, intractable adverse events and serious infection. Conclusion Adalimumab can treat rheumatoid arthritis failing to respond to DMARDs, but clinically the doctor should balance the benefit and the risk of the adalimumab.
【摘要】随着超声心动图的普及与发展,无症状性类风湿性关节炎心脏瓣膜改变的检出率逐渐增多。临床应重视类风湿性关节炎心脏瓣膜损害以及超声心动图在这类疾病中的诊断价值,以期改善患者预后。【Abstract】 Objective More and more cardiac valve changes are detected in asymptomatic patients with rheumatoid arthritis by echocardiography. It is essential to pay attention to the clinical features of heart valves damage and the diagnostic value of echocardiography on that in order to improve the prognosis of patients.
Therapeutic drug monitoring (TDM) has been more widely used in small molecule agents, such as immuno-suppressants, antiepileptic drugs and antibiotics, with less attention in the field of therapeutic biological agents. Monoclonal drugs represented by tumor necrosis factor alpha (TNF-α) inhibitors have shown a good relationship between exposure and efficacy in clinical studies. There are corresponding guidelines and consensus for the recommendations of TDM based on current research evidence. Therefore, this paper introduced the current evidence, strategies and considerations for TDM in the optimal treatment of adalimumab from the perspective of adalimumab TDM to provide references for the clinical practice of adalimumab TDM.
Objective To evaluate diagnostic value of antifilaggrin autoantibodies (AFA) for rheumatoid arthritis (RA). Methods A systematic, comprehensive literature search was conducted in PubMed (1966 to 2010.8), The Cochrane Library (issue 8, 2010), EMbase (1974 to 2010.8), CBM (1978 to 2010.8), CNKI (1994 to 2010.8), VIP (1989 to 2010.8) and Chinese Medical Association of Digital Periodicals (1997 to 2010.8). The diagnosis studies on AFA versus the standards of American College of Rheumatology for RA were included. QUADAS items were used to evaluate the quality of the included studies. Meta-disc software (version 1.4) was used to analyze data. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (–LR) and summary receiver operating characteristic curve (SROC) were calculated to assess the diagnostic value of individual diagnostic tests. Results A total of 18 articles were included, involving 6 971 cases of subjects from 7 countries. Results of meta-analysis showed that, compared with the standards of American College of Rheumatology, pooled SEN, SPE, +LR, –LR, and SROC curve of AFA were 0.52 (0.50, 0.54), 0.93 (0.92, 0.94), 7.11 (5.35, 9.45), 0.53 (0.48, 0.60), 13.82 (9.93, 19.24), and 0.834 7, respectively. Conclusion IBT, ELISA detection of AFA are of high efficiency in the diagnosis of RA. However, the antigen from human breast skin is not conducive to clinical application.
ObjectiveTo evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. MethodsBetween September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. ResultsOne-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones (P < 0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of > 2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up (P > 0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint (P < 0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found (P > 0.05). ConclusionA combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.
Objective To evaluate the surgical treatment and effectiveness of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. Methods Between January 2007 and August 2009, 7 patients with rheumatoid forefoot were treated by reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. They were all females with an average age of 62 years (range, 56-71 years) and with an average disease duration of 16 years (range, 5-30 years). All patients manifested hallux valgus, hammer toe or mallet toe of 2-5 toes, 5 feet complicated by subluxation of the second metatarsophalangeal joint. The improved American Orthopaedic Foot amp; Ankle Society (AOFAS) score was 36.9 ± 6.4. The hallux valgus angle was (46 ± 5)°, and the intermetarsal angle was (12 ± 2)° by measuring the load bearing X-ray films preoperatively. Results All incisions healed by first intention after operation. The X-ray films showed bone fusion of the first metatarsophalangeal joint at 3-4 months after operation. Seven patients were followed up 2.9 years on average (range, 2-4 years), gait was improved and pain was rel ieved. The hallux valgus angle decreased to (17 ± 4)° and the intermetarsal angle was (11 ± 2)° at 3 months postoperatively, showing significant differences when compared with preoperative values (P lt; 0.05). The improved AOFAS score was 85.3 ± 5.1 at 2 years postoperatively, showing significant difference when compared with preoperative score (t=4.501, P=0.001). One patient had recurrent metatarsalgia at 4 years after operation. Conclusion Arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads for rheumatoid forefoot reconstruction can correct hallux valgus, remodel the bearing surface of the forefoot, and rel ieve pain, so it can be considered as a procedure that provides improvement in the cl inical outcome.
Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. It mainly involves joints, as well as extra-articular organs. The extra-articular manifestations (EAM) are more common in patients with severe active disease, and the mortality of RA patients with EAM is 2.5 times of RA patients without EAM. Renal damage is rare in EAM, which mainly includes renal damage associated with RA itself, renal amyloidosis, and drug-induced secondary renal damage. In recent years, researches on RA renal damage have gradually increased, and mainly focused on therapy and prognosis. The recent research progress of RA renal damage are summarized in this review.