ObjectiveTo evaluate the effectiveness of total hip arthroplasty (THA) with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis (RA) with protrusio acetabuli. MethodsBetween January 2001 and April 2009, 18 cases (20 hips) of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years (range, 36-62 years). The disease duration was 3-10 years (mean, 6 years). Preoperative Harris score was 40.25±6.68. The protrusio acetabuli was (5.70±4.26) mm. According to Sotelo-Garza and Charnley classification criterion, there were 12 hips of type 1 (protrusio acetabuli 1-5 mm), 5 hips of type 2 (6-15 mm), and 3 hips of type 3 (>15 mm). All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation. ResultsThe average operation time was 74 minutes (range, 48-126 minutes); the average blood loss was 350 mL (range, 150-650 mL). Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months (range, 60-156 months). According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20±4.21, showing significant difference when compared with preoperative score (t=-27.68, P=0.00); the protrusio acetabuli was (-1.11±0.45) mm, showing significant difference when compared with preoperative value (t=5.66, P=0.00). No loosening of acetabular components was found. ConclusionFor RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium term effectiveness.
Objective To get known about the disease burden and quality of life (QOL) of rheumatoid arthritis (RA) in China by conducting a systematic review. Methods The observational studies about the disease burden and QOL of RA in China were systematically searched in the following databases: CNKI, CBM, VIP, WanFang Data, MEDLINE/Pub Med, EMbase, and Science Citation Index. The retrieval time was from January 1st, 1990 to July 31st, 2010. According to the inclusion and exclusion criteria, the literature was screened, the data were extracted, and the methodological quality of the included studies was assessed. The morbidity of RA was pooled by adopting generic inverse variance model, the meta-analyses on 8 dimensions of SF-36 life quality score (LQS) was conducted by suing RevMan5.0 software, the weighted mean difference (WMD) was regarded as the indicator of intervention effect, and the impact of studies’ quality on the results was assessed by sensitivity analysis. Results A total of 20 studies with medium quality in general were included. The morbidity of RA was 14.7/100 000. The disability adjusted of life years (DALYs) per capita were 4.92. If excluding the cost resulted from DALY, the overall economic cost was RMB 1 250.45 yuan per capita per year; While considering DALY, the cost was RMB 15 717.91 yuan per capita per year. The average cost of outpatient medications was RMB 8 018±17 238 yuan per capita per year. The weighted morbidity was 0.42% (95%CI 0.39% to 0.45%), and it was higher in female than male (Plt;0.05). There was no secular trend and difference between southern and northern (Pgt;0.05), but there were statistical significances in the WMD of 8 dimensions of SF-36 LQS. Sensitivity analyses revealed that the weighted pooled results were stable. Conclusion The epidemiological and economic burden of rheumatoid arthritis are heavier in China, which needs to be concerned by both government and society.
Objective To systematically review the effectiveness and safety of total hip arthroplasty (THA) vs. total hip resurfacing arthroplasty (THRA) in patients with osteoarthritis of the hip joint. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 3, 2012), EMbase, PloS, national institutes of clinical test library of the United States, national joint replacement registration network of Australia, British national joint registration network, British orthopaedic association network (BOA), Canada orthopaedic association (COA), American Academy of Orthopedic Surgeons network (AAOS), German Institute of Medical Documentation and Information network (DIMDI) for randomized controlled trials (RCTs) on the comparison between THA and THRA for osteoarthritis of the hip joint from inception to November, 2012. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Six RCTs (10 articles) involving 518 cases of surgery (THA: n=259; THRA: n=259) were identified. The risk of bias of 8 articles was moderate and that of the other 2 articles was low. The results of meta-analysis showed that, compared to THRA, THA brings greater improvements of femoral offset within 2 years after surgery (MD=6.60, 95%CI 5.53 to 7.68, P=0.25). There were no significant differences between the two groups in Merle d’Aubigné Postel, WOMAC score, UCLA score, SF-36 Health Survey Questionnaire, walking speed, step length, walking cadence, postoperative leg length discrepancy, and complication rates. All these conclusions are based on early postoperative results. Conclusion Current evidence shows that, THA brings greater improvements of femoral offset than THRA, and no significant differences between the two groups were found in the other indicators.
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.
Objective To evaluate the quality of diagnostic studies on detecting anti-cyclic citrullonated peptide antibody to diagnose rheumatoid arthritis. Methods We searched PubMed, EMbase, The Cochrane Library, and CBM to collect studies on using anti-cyclic citrullonated peptide antibody to diagnose rheumatoid arthritis. QUADAS items were used to evaluate the quality of included studies. Results A total of 195 studies were included. Sixty-nine were English studies and 126 were Chinese studies. All studies had good descriptions of the spectrum of patients and little potential for partial verification bias, differential verification bias, and incorporation bias. However, most studies were prone to disease progression bias, review bias, and clinical review bias. One study did not explain the intermediate test results, and another did not report part of the test results. The overall quality of English studies was better than that of Chinese studies. Conclusion The potential bias of the included studies mainly resulted from the absence of blinding when interpreting the test results. The reporting quality of the included studies was poor.
Objective To investigate the effectiveness, safety and cost-effectiveness of leflunomide for rheumatoid arthritis, and formulate an evidence-based treatment plan for a patient with rheumatoid arthritis. Methods We searched the ACP Journal Club, The Cochrane Library (Issue 2, 2007) and MEDLINE (1990 to 2007), and critically appraised the available evidence. Results The available Level A (high quality) evidence showed that the efficacy and adverse events of leflunomide were comparable to those of methotrexate. The total cost of treating patients with leflunomide was significantly higher when compared to methotrexate. The combination of leflunomide and methotrexate in patients with active rheumatoid arthritis unresponsive to methotrexate monotherapy was less costly and more effective than the strategy excluding leflunomide. Given the current evidence, together with our clinical experience and the patient’s preference, methotrexate was administered to the patient. There was an inadequate response after 6 months of treatment. And then, adding leflunomide to methotrexate attained a remarkable response 3 months later. The patient is still being followed up. Conclusion treatment with leflunomide and methotrexate in RA patients can improve the clinical outcomes. Long-term efficacy and toxicity remain to be established.
目的 探讨抗环瓜氨酸肽抗体（anti-CCP）与类风湿因子（RF）对类风湿关节炎（RA）的诊断效能，及RF分型检测在RA活动度判断中的价值。 方法 选取2012年3月－2013年2月就诊的64例RA患者为病例组，103例其他自身免疫性疾病患者为对照组，用酶联免疫吸附试验分别检测anti-CCP和RF-IgM/IgG/IgA，收集数据进行统计分析。 结果 anti-CCP与RF联合指标对RA的诊断灵敏度最高（92.2%），anti-CCP的特异度最高（95.1%）；RF-IgA的水平与骨关节侵蚀程度呈正相关（rs=0.987，P=0.000）；RF的3个亚型都可反映RA疾病的活动度（P＜0.05）。 结论 anti-CCP与RF联合诊断RA，可显著提高诊断灵敏度，RF的分型检测对于RA患者的活动度监测有重要价值。
目的 探讨盐酸氨基葡萄糖胶囊联合透明质酸钠注射液治疗髋骨关节炎的临床疗效。 方法 纳入疼痛门诊2010年7月－2011年7月收治的髋骨关节炎患者60例，随机分为透明质酸钠关节腔内注射联合口服盐酸氨基葡萄糖胶囊组（A组）和单独透明质酸钠关节腔内注射组（B组），每组30例。透明质酸钠关节腔内注射均为2.5 mL/次，每周1次，连续5周为1疗程。盐酸氨基葡萄糖胶囊口服，0.75 g/次，2次/d，6周为1个疗程。评估两组患者治疗后6周后髋关节疼痛视觉模拟评分（VAS评分）及Lequesne指数评定髋关节休息痛、运动痛、局部压痛、关节活动度、晨僵及行走能力，并观察两组不良反应发生情况。 结果 治疗6周后A组Lequesne功能指数及VAS评分较B组显著降低（P＜0.05），两组不良反应比较差异无统计学意义（P＞0.05）。 结论 治疗髋骨关节炎患者时，联合应用透明质酸钠及盐酸氨基葡萄糖胶囊疗效优于单独应用透明质酸钠者，且并未增加不良反应的发生。
目的 观察盐酸氨基葡萄糖治疗膝骨关节炎的临床效果。 方法 将2010年10月－2011年12月收治的70例膝骨关节炎患者随机分为观察组和对照组，每组各35例。对照组单纯口服对乙酰氨基酚；观察组在对照组基础上加用盐酸氨基葡萄糖。观察两组临床疗效和不良反应。 结果 观察组总有效率高于对照组，不良反应发生率低于对照组，两组比较差异均有统计学意义（P＜0.05）。 结论 盐酸氨基葡萄糖治疗膝骨关节炎安全有效。