DMARDs联合关节镜下滑膜清理术治疗类风湿性关节炎的研究

DMARDs and arthroscopic synovectomy for the treatment of rheumatoid arthritis

目的探讨DMARDs联合关节镜下滑膜清理术治疗类风湿性关节炎(RA)的价值。方法46例RA患者在使用DMARDs等药物的同时,应用关节镜对患者的52个膝关节在关节镜下行滑膜清理术(双侧膝关节6例,单侧膝关节40例),术后即在关节腔内注射复方倍他米松(二丙酸倍他米松及倍他米松磷酸盐)注射液及透明质酸钠4ml,且继续前DMARDs药物治疗。对患者进行手术前后关节疼痛VAS量表评分,Ishikawa关节功能的评定,检测手术前后血沉(ESR),C反应蛋白(CRP)及类风湿因子(RF)。结果所有患者在术后1周内诉全身和手术关节肿痛减轻;术后2周,VAS量表评分、ESR、CRP下降,与术前比较差异均有统计学意义(均P<0.05);术后4周,ESR和CRP的下降幅度超过65%,27例患者的ESR和CRP在正常范围,18例患者RF下降达60%;术后3个月,38例患者的ESR和CRP在正常范围,29例RF≤30IU/ml,手术前后各指标比较差异均有统计学意义(均P<0.05或0.01)。术后6个月,关节功能的总优良率为94.2%;术后2年,关节功能的总优良率为80.0%。结论对早中期RA患者进行DMARDs联合关节镜下膝关节滑膜清理术,近期疗效满意,除手术关节功能恢复外,亦可改善患者的全身症状。

Objective To evaluate the administration of disease-modifying antirheumatic drugs （DMARDs） combined with arthroscopic synovectomy for patients with rheumatoid arthritis （RA）. Methods Forty six patients with rheumatoid arthritis （52 knees） were treated with DMARDs combined with arthroscopic synovectomy. Compound betamethasone injection and sodium hyaluronate injection were administrated in the knee joints after operation, and DMARDs were given continuously. All the 52 knees were followed up for 6 months and 35 knees were followed up for 2 years. During the follow-up the joint pain was assessed with VAS scoring; knee function with Ishikawa＇s scoring system. Erythrocyte sedimentary rate （ESR）, C-reactive protein （CRP） and rheumatoid factor （RF） were measured before and after operation. Results Tenderness and swelling of the knees were relieved in one week. The levels of ESR, CRP and RF were decreased significantly in the different period. The rate of excellent and good scores in Ishikawa＇s system was 94.2% 6 months after operation. Conclusion The short-term follow-up indicates that DMARDs combined with arthroscopic synovectomy are effective in the management of early and mid-stage rheumatoid arthritis.