【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 report the clinical experience of using Ilizarov wrist joint distraction technique in the treatment of a case of rheumatoid arthritis of the wrist. Methods In January 2019, a 49-year-old female patient with rheumatoid arthritis of the left wrist, complicated by ulnar impaction syndrome, was admitted for treatment. Preoperatively, the active range of motion of the left wrist was as follows: extension 0°-flexion 0°, pronation 65°-supination 35°, and grip strength of 4.0 kg. The visual analogue scale (VAS) score was 9, and the Cooney wrist function score was 15, indicating poor function. As conservative treatment failed to achieve symptom relief, Ilizarov wrist joint distraction surgery was performed. Postoperatively, joint distraction was applied at 2 mm increments on postoperative days 2 and 7, in 4 separate sessions. Results Postoperative X-ray film examination at 7 days revealed a distraction of 3.6 mm in the affected wrist joint compared to the contralateral side. The external fixator was removed 2.5 months postoperatively. At 22 months postoperatively, X-ray film and MRI examinations revealed that the joint space of the left wrist had returned to near-normal, with significant reduction in joint effusion and synovial proliferation. The active range of motion of the left wrist improved to extension 15°- flexion 30°, pronation 90°-supination 90°, with a grip strength of 18.0 kg. The wrist pain VAS score decreased to 0, and the Cooney wrist function score improved to 90, indicating excellent function. At 50 months postoperatively, follow-up X-ray film, MRI, and functional assessments showed the results similar to those at 22 months. Conclusion Ilizarov wrist joint distraction may be a viable treatment option for rheumatoid arthritis of the wrist.
Objective To analyse the results of posterior cruciate l igament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the cl inical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate l igament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabil ized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate l igament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average diseasecourse of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P gt; 0.05) in general data between groups A and B, but there were significant differences (P lt; 0.05) when compared with group C. Results In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor heal ing of incision, respectively; in group C, all cases had good heal ing of incision. There were significant differences in heal ing rate of incision between groups A, B and group C (P lt; 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P gt; 0.05). Posterior instabil ity occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instabil ity occurred in group B; showing significant differences between groups A, C and group B (P lt; 0.05). There were significant differences (P lt; 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P lt; 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate l igament-retained mobile-bearing TKA can yield satisfactory cl inical results in treatment of RA at intermediate-term followup. This mobile-bearing prosthesis has a low prevalence of posterior instabil ity and a good outcome for anterior knee function without patellar resurfacing.
Objective To explore the technique of the soft tissue balancing in the total knee arthroplasty (TKA) for the patients of rheumatoid arthritis with flexion contracture. Methods From November 1997 to May 2006, 38 patients with rheumatoid arthritis with flexion contracture underwent primary bilateral TKA and balancing of the soft tissues, among whomthere were 8 males and 30 females, aged 48-71 years old (58.2 on average). The course of disease was 28 months-16 years (7.6 years on average). The preoperative flexion contracture was (38.2 ± 11.3)°. The average range of motion (ROM) and HSS score were (49.1 ± 17.8)° and 23.9 ± 16.9, respectively. According to the preoperative flexion-contracture degree of the knees, these patients were divided into 3 levels: 5 patients with ≤ 20°, 26 patients with 20-60° and 7 patients with ≥ 60°. During the TKA procedure, based on the correct osteotomy, different methods of soft tissue balancing were used for different degrees of flexion contracture. The TKA soft tissue treatment was summed up as the releasing of posterior structures and the balancing between medial collateral ligaments (MCL) and lateral collateral ligaments (LCL), etc. Results The flexion contractures in 38 cases were all improved after the operation, among which 33 patients had a complete correction and only 5 patients had a residual flexion contracture of 5-10°. Eight knees suffered from complications within 1 week after operation, among which 3 had subcutaneous superficial infection and 5 had deep vein thrombus (DVT). These patients obtained good heal ing after active treatment. All the 38 patients were followedup for 10 months to 8 years with the median time of 37 months. The postoperative flexion deformity declined to (2.4 ± 5.7)°, and the ROM and HSS scores were (96.3 ± 14.6)° and 81.7 ± 10.4, respectively. There was statistical difference (P lt; 0.05). According to the HSS score, 27 patients (71.05%)were rated as excellent, 6 good (15.79%) and 5 fair (13.16%), and the choiceness rate was 86.84%. Conclusion The balancing of the soft tissue is a major treatment for correction of the flexion contracture, which can avoid bone over-resection during the surgery of TKA. The proper balancing of the soft tissue can not only achieve an obvious correction of the flexion contracture but also effectively improve the range of motion and the functional recovery of the knee joint after TKA.
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.
ObjectiveTo investigate the potential causal relationship between four types of reproductive behaviors and rheumatoid arthritis (RA), with the goal of establishing a theoretical foundation for clinical prevention and treatment strategies. MethodsPooled gene-wide association study (GWAS) data were obtained from large publicly searchable databases. Four characteristics like menarche, menopause, the age of first pregnancy and the age of last pregnancy, which related to reproductive behavior were selected as the exposure factors and RA as the outcome factors. Single nucleotide polymorphisms (SNPs), which were strongly correlated with the phenotype of the exposure factors, were screened as the instrumental variables, and two-sample Mendelian randomization analyses were used to assess the potential causal relationship between the exposure and the disease. Results① The Mendelian randomization analysis utilizing the inverse variance weighted method on two distinct samples revealed a significant negative correlation between the age of first pregnancy and last pregnancy with the risk of RA (OR=0.91, 95%CI 0.85 to 0.98, P=0.011; OR=0.54, 95%CI 0.31 to 0.93, P=0.026). Conversely, no causal relationship was observed between menarche and menopause with RA. Sensitivity analysis confirmed the robustness of the causal relationship, while MR Egger intercept analysis did not identify any potential horizontal pleiotropy (Page of first gestation -RA=0.169, Page of last gestation -RA=0.283). ② Reverse Mendelian randomization analysis revealed a significant positive causal association between RA and the age of first pregnancy, while no causal relationship was observed with the age of last pregnancy (OR=1.07, 95%CI 1.02 to 1.11, P=0.001). ③ Multivariate Mendelian randomization analysis demonstrated that both the age of first pregnancy and last pregnancy in women were inversely associated with the risk of RA (OR=0.88, 95%CI 0.80 to 0.97, P=0.010; OR=0.68, 95%CI 0.48 to 0.97, P=0.033). ④ There existed a negative correlation between the age of pregnancy in women and the risk of developing RA, suggesting a potential protective effect. ConclusionPregnancy age may have a negative causal relationship with the risk of RA, while menarche and menopause have no causal relationship with RA.
Objective To investigate the surgical planning and the mid-term effectiveness of four major lower extremity arthroplasties (4JA) in patients with rheumatoid arthritis (RA). Methods A clinical data of 25 patients with RA, who received 4JA and were followed up more than 3 years between June 2012 and September 2018, was retrospectively analyzed. There were 3 males and 22 females, with an average age of 48.6 years (range, 27-80 years). The body mass index ranged from 16.0 to 28.4 kg/m2, with an average of 20.48 kg/m2. The duration of RA ranged from 2 to 35 years (median, 21 years). There were 8 cases (12 sides) of knee valgus, 6 cases (12 side) of acetabular retraction, and 5 cases (10 sides) of hip stiffness. Among them, 20 patients underwent hip surgery first, and 5 patients underwent knee surgery first. Hip joint function was evaluated by Harris score, Hip Disability and Osteoarthritis Outcome Score (HOOS), hip range of motion, and Trendelenburg sign; knee joint function was evaluated by American Hospital for Special Surgery (HSS) score, knee range of motion and muscle strength, and a timed up and go (TUG) test was performed at last follow-up. X-ray films were used to observe whether the prosthesis was loose or displaced. Results All 25 patients completed 4JA. Only 1 patient (1 side) had incision infection after operation, 3 patients (3 sides) had proximal femur fractures during operation. All patients were followed up 3.0-8.8 years, with an average of 5.8 years. At last follow-up, the Harris score, HOOS score, and range of motion of flexion, extension, and abduction of the hip joint significantly improved when compared with those before operation, and the patients with positive Trendelenburg sign decreased. The HSS score and range of motion of flexion and extension of the knee joint also significantly improved when compared with those before operation. There were significant differences in all indexes between pre- and post-operation (P<0.05). The muscle strength was grade V. The TUG test ranged from 7.8 to 15.34 seconds (mean,10.79 seconds). X-ray films showed the prosthesis was not loose or displaced. Conclusion When RA patients receive 4JA, adequate preoperative evaluation, rational selection of the timing and sequence of surgery, and maximal restoration of lower limb alignment can achieve good mid-term effectiveness.