抗风湿药联合超声引导关节介入治疗类风湿关节炎的价值研究

Effect of antirheumatic drugs combined with ultrasound-guided joint interventional therapy on rheumatoid arthritis

目的比较抗风湿药联合超声引导(USG)下复方倍他米松注射治疗与常规抗风湿药治疗类风湿关节炎(RA)的疗效。方法选取2017年3月—2019年2月在上海中医药大学附属曙光医院明确诊断为活动期RA且伴有局部关节肿痛的患者72例,其中男10例、女62例,采用随机数字表法将患者分为研究组和对照组,每组各36例。研究组给予口服抗风湿药联合单次USG下关节内注射复方倍他米松,对照组仅给予口服抗风湿药治疗。记录患者的一般资料和受累关节情况,记录两组患者治疗前和治疗后2、6、12周的疼痛VAS评分和28关节疾病活动度评分法(DAS28)评分及其降低幅度。比较两组患者的滑膜厚度、滑膜血流、关节积液情况。结果两组间患者的性别构成、年龄、病程、滑膜厚度,以及治疗前各滑膜血流分级和各关节受累患者构成的差异均无统计学意义(P值均>0.05)。两组间治疗前疼痛VAS评分、DAS28评分的差异均无统计学意义(P值均>0.05),研究组治疗后2、6、12周的疼痛VAS评分和DAS28评分均显著低于对照组同时间(P值均<0.01)。两组治疗后2、6、12周疼痛VAS评分和DAS28评分均显著低于同组治疗前(P值均<0.05),研究组治疗后2、6、12周的疼痛VAS评分和DAS28评分的降低幅度均显著大于对照组同时间(P值均<0.05)。两组治疗后2、6、12周滑膜厚度、滑膜血流分级患者构成比均显著低于同组治疗前(P值均<0.05),研究组治疗后2、6、12周滑膜厚度、滑膜血流分级患者构成比均显著低于对照组同时间(P值均<0.01),两组间治疗后关节滑膜厚度的差异无统计学意义(P=0.182)。两组治疗不同时间的滑膜厚度和各滑膜血流分级患者构成比的差异均有统计学意义(P值均<0.001),治疗后12周内滑膜血流分级患者构成比随时间延长而降低(P<0.001),治疗后6周内滑膜厚度随时间延长而减小(P<0.001),治疗后6至12周滑膜厚度不随时间延长而显著改变(P=0.522)。研究组治疗后12周有关节积液的患者比例显著低于对照组(P=0.042)。两组患者治疗后均无明显不良反应发生。结论抗风湿药联合USG关节介入治疗较常规抗风湿药治疗中短期内可明显延缓关节炎症进展和改善临床评分。

Objective To compare antirheumatic drugs combined with ultrasound-guided compound betamethasone injection and conventional antirheumatic drugs in the treatment of rheumatoid arthritis(RA).Methods A total of 72 patients(10 males and 62 females)who were diagnosed as active RA between March 2017 and February 2019 and had local joint swelling and pain were randomly divided into study group and control group(36 cases in each group).All the patients were given oral antirheumatic drugs.Additionally,the patients of study group were treated with ultrasound-guided intra-articular compound betamethasone.Patients’general information and affected joints were recorded.Visual analogue score(VAS)and disease activity score in 28 joints(DAS28)were recorded before treatment,at 2 weeks,6 weeks and 12 weeks after treatment.Synovial thickness,synovial blood flow and joint effusion were measured.Results There was no significant difference in gender composition,age,course of disease,synovial thickness,or composition of patients with joint involvement between the two groups(P>0.05);neither were VAS,DAS28,nor synovial blood flow before treatment(P>0.05).The VAS,DAS28,decreased VAS,decreased DAS28,synovial thickness and synovial blood flow of the study group were significantly lower than those of the control group at 2,6 and 12 weeks after treatment(P<0.01,0.05).The VAS,DAS28,synovial thickness and synovial blood flow of the two groups at 2,6 and 12 weeks after treatment were significantly lower than those before treatment(P<0.05).There was no significant difference in joint synovial thickness between the two groups after treatment(P=0.182).There were significant differences in synovial thickness and synovial blood flow between the two groups at different time points of treatment(P<0.001).The synovial blood flow decreased with time within 12 weeks after treatment(P<0.001).The synovial thickness decreased with time within 6 weeks after treatment(P<0.001),but it did not change significantly with time from 6 to 12 weeks after treatment(P=0.522).The proportion of patients with joint effusion at 12 weeks after treatment was significantly lower in the study group than that in the control group(P=0.042).There were no obvious adverse reactions after treatment.Conclusion Compared with conventional antirheumatic drugs,antirheumatic drugs combined with ultrasound-guided joint interventional therapy can significantly improve the progression of joint inflammation and clinical score in the short and medium term.