【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.
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.
【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.
Objective To evaluate the diagnostic value of antikeratin antibody (AKA) for rheumatoid arthritis (RA). Methods Systematic and comprehensive literature was searched in PubMed (1966 to June 2010), The Cochrane Library (Issue 6, 2010), CBM (1978 to June 2010), CNKI (1994 to June 2010), VIP (1989 to June 2010), and CMA Digital Periodicals (1997 to June 2010). The diagnosis studies of antikeratin antibody for rheumatoid arthritis were included. The quality assessment of diagnostic accuracy studies (QUADAS) items were used to assess the quality of the included studies. The Meta-Disc (version 1.4) software was used to analyze the data. Results A total of 69 trials involving 14 890 participants were included. The results of meta-analyses showed that compared with the RA classification criteria revised by American Rheumatism Association (ARA), the summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, OR value, and summary receiver operating characteristic curve of antikeratin antibody were 0.41 (0.39, 0.42), 0.94 (0.94, 0.95), 9.52 (7.21, 12.57), 0.63 (0.60, 0.66), 15.24 (11.62, 19.98), and 0.613 6, respectively. Conclusion Antikeratin antibody might be one of the most effective diagnoses for rheumatoid arthritis. The clinicians should combine other autoantibodies with AKA to diagnose rheumatoid arthritis.
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 efficacy and safety of Celecoxib and Naproxen for treating osteoarthritis or rheumatoid arthritis.Methods Such databases as EMbase, PubMed, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China Journal Full-text Database (CJFD), and Chinese Scientific Journal Full-text Database (CSJD) were searched to collect the randomized controlled trials (RCTs) of Celecoxib and Naproxen for treating osteoarthritis or rheumatoid arthritis. Two reviewers independently assessed the quality of the included studies and extracted the data. The Review Manager (version 5.0) software was used to analyze the data. Results Four RCTs involving 2 931 patients were included. The results of meta-analyses were as follows: a) There were significant differences in the dose of Celecoxib and Naproxen for treating rheumatoid arthritis or osteoarthritis; b) There was no significant difference in gastrointestinal reaction between the Celecoxib group and the placebo group (RR=1.29, 95%CI 0.93 to 1.79); c) The were significant differences in gastrointestinal reaction between the Celecoxib group and the Naproxen group (RR=0.78, 95%CI 0.64 to 0.95); d) There were significant differences in inducing the severity of Stomach and Duodenum Endoscopy Score between the Celecoxib group and the Naproxen group when treating rheumatoid arthritis or osteoarthritis (RR=1.29, 95%CI 0.93 to 1.79). As the Intention-To-Treat (ITT) analysis showed, there were significant differences in inducing the severity of gastrointestinal reaction between the Celecoxib group and the Naproxen group when treating rheumatoid arthritis or osteoarthritis (RR=0.84, 95%CI 0.77 to 0.92). Conclusion Compared with Naproxen, there are significant differences in efficacy for treating rheumatoid arthritis and osteoarthritis with Celecoxib in different doses. The Celecoxib has no significant difference in gastrointestinal reaction compared with the placebo group. The Celecoxib group has fewer gastrointestinal side-effects as compared with the Naproxen group, so it can be used to treat rheumatoid arthritis and osteoarthritis in clinic. The results still need to be confirmed by high-quality RCTs.
Rheumatoid arthritis is a chronic inflammatory disorder. It is characterized by a chronic polyarthritis that primarily affects the peripheral joints and related periarticular tissues. To a patient with rheumatoid arthritis, we searched the evidence and indentified the best available therapy for him: ① Ibuprofen was used to relieve pain. ② Methopterin ivgtt qw and oral methopterin after the discharge for 12 months. ③ Oral omeprazole 20 mg/d to prevent peptic ulcear. ④ Administration with fish oil and physical exercises after discharge were recommended.