关节腔内注射TNF-α拮抗剂治疗类风湿关节炎的疗效

Therapeutic efficacy of intra-articular injection of TNF-αantagonist in the treatment of rheumatoid arthritis

目的观察类风湿关节炎(RA)患者关节腔内注射TNF-α拮抗剂的疗效。方法79例RA患者分为两组:治疗组49例,关节腔内注射TNF-α拮抗剂25 mg,2周1次,连续注射3~5次;对照组30例,关节腔内注射1 mL复方倍他米松1次。评估治疗第2、4、8、12和24周时关节肿胀和疼痛情况。记录随访6个月内两组关节炎复发情况和治疗相关不良反应发生情况。结果与治疗前相比,治疗组第8周起滑膜厚度改善(P<0.05),对照组第4周起改善(P<0.05)。两组第2周起关节积液均较治疗前减少(P<0.05),第12周起滑膜多普勒血流信号减轻(P<0.05),第2周起VAS疼痛评分减少(P<0.05)。两组治疗前后ESR和CRP水平无统计学差异(P>0.05)。治疗组关节炎复发率为24.49%(12/49),低于对照组的43.33%(13/30)。两组均未见明显治疗相关不良反应。结论关节腔内注射TNF-α拮抗剂治疗RA患者安全、有效。

Objective To observe the efficacy of intra-articular injection of TNF-αantagonist in the patients with rheumatoid arthritis(RA).Methods A total of 79 RA patients were divided into two groups.The patients in group A(49 cases)were treated with intra-articular injection of 25 mg TNF-αantagonist once every two weeks,3 to 5 times consecutively.The patients in group C(30 cases)were treated with intra-articular injection of 1 mL betamethasone once.The changes of joint swelling and pain were evaluated at the time points of the 2th,4th,8th,12th and 24th week of the tratment.The recurrence of arthritis and the occurrence of treatment-related adverse reactions were recorded in two groups within 6 months of follow-up.Results Compared with before treatment,the synovial hypertrophy was significantly improved from the 8th week in group A and from the 4th week in group C(P<0.05),the synovial effusion of two groups was significantly reduced from the 2th week(P<0.05),power Doppler signal was significantly decreased in both groups from the 12th week(P<0.05),and the VAS pain scores of both groups were significantly decreased from the 2th week(P<0.05).There were no significant differences in ESR and CRP levels before and after treatment in two groups(P>0.05).The arthritis recurrence rate was lower in group A than that in group C(24.49%vs.43.33%).No obvious treatment-related adverse reactions were observed in the two groups.Conclusion Intra-articular injection of TNF-αantagonist is safe and effective in the treatment of RA patients.