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.
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.
Objectives To systematically review the efficacy and safety of certolizumab pegol (CZP) plus methotrexate (MTX) for active rheumatoid arthritis. Methods The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) on CZP plus MTX vs. MTX plus placebo for active rheumatoid arthritis from inception to May, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were analyzed by using Stata 11.0 software. Results Seven RCTs were included. The results of meta-analysis showed the CZP plus MTX group was superior to MTX plus placebo group in ACR20 (CZP400 mg: RR=2.86, 95%CI 1.70 to 4.79, P<0.001; CZP200 mg: RR=3.76, 95%CI 2.59, 5.46, P<0.001), ACR50 (CZP400 mg: RR=3.91, 95%CI 2.10 to 7.27, P<0.001; CZP200 mg: RR=4.86, 95%CI 3.20 to 7.39, P<0.001), and ACR70 (CZP400 mg: RR=5.65, 95%CI 1.99 to 16.06, P=0.001; CZP200 mg: RR=10.08, 95%CI 5.11 to 19.89, P<0.001). The CZP plus MTX group was also superior to MTX plus placebo group in swollen joint counts (SMD=–12.72, 95%CI –15.39 to –10.06,P<0.001), tender joint counts (SMD=–11.54, 95%CI –13.97 to –9.11,P<0.001), doctor's global assessment of disease activity (SMD=–11.78, 95%CI –13.81 to –9.75,P<0.001), patient's global assessment of disease activity (SMD=–9.62, 95%CI –11.09 to –8.15,P<0.001), and patient's assessment of pain (SMD=–9.10, 95%CI –10.91 to –7.30,P<0.001) and HAQ (SMD=–7.74, 95%CI –8.99, –6.49,P<0.001), respectively. However, the incidence of adverse events in CZP plus MTX group was higher than that in MTX plus placebo group. Conclusions CZP plus MTX is superior to MTX plus placebo for treatment of active rheumatoid arthritis but with higher adverse events. Due to limited quantity and quality of the included studies, the above conclusions are still needed to be verified by more high-quality studies.
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 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.
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.