摘要:目的:评价膝关节滑膜超声检查在类风湿关节炎(RA)患者随访中的价值及其与RA临床活动度之间的相关性。方法:收集确诊的RA病人40例,其中68个膝关节有阳性症状。分别收集40例RA患者的临床资料,计算其疾病活动度DSA28,同时行膝关节超声检查,对有阳性症状的膝关节动态随访三次上述指标,每月一次。结果:每月RA患者的DSA28分值与受检膝关节髌上囊内液体深度、滑膜内血流信号等级呈正相关(Plt;0.05);膝关节髌上囊内液体深度、滑膜内血流信号等级以及滑膜厚度三者之间均呈正相关(Plt;0.05)。结论:膝关节滑膜内血流信号等级和膝关节髌上囊内液体深度是良好的随访RA患者疗效与评估RA患者活动度的超声指标。Abstract: Objective: To evaluation the disease of synovial in knee joints in patients with RA by ultrasound, and investigate the relationship between the clinic activity of RA and findings by ultrasound. Methods: The clinic dates and ultrasound of 40 RA patients, including 68 knee joints have positive symptom were collected by every month. The course of treatment was 3 months. Results: The score of DSA28 was correlated with the thick of effusion in bursa supragenual and the blood single of synovial in knee joints(Plt;0.05);the correlation also found among the thick of effusion in bursa supragenual.the thick of synovial and the blood singal of synovial in knee joints (Plt;0.05). Conclusion: The thick of effusion in bursa supragenual and the blood single of synovial in knee joints was excellent ultrasound index in RA.
ObjectiveTo investigate the effectiveness of total elbow arthroplasty (TEA) with preservation of triceps brachii insertion approach.MethodsBetween January 2012 and September 2017, 17 patients with elbow disease were treated with TEA with preservation of triceps brachii insertion approach. There were 3 males and 14 females, with an average age of 65.2 years (range, 48-85 years). The injuries located on left elbow in 5 cases and on right elbow in 12 cases. There were 11 cases of distal humerus fracture (AO type C1 in 2 cases and type C3 in 9 cases); the interval between fracture and operation was 3-10 days (mean, 4.1 days). There were 3 cases of osteoarthritis and 3 cases of rheumatoid arthritis, with the disease duration of 2-26 years (mean, 8.7 years). The postoperative elbow function and pain was assessed by Mayo elbow performance score (MEPS) and visual analogue scale (VAS) score, respectively. The prosthesis position, heterotopic ossification, and periprosthetic fracture were observed by X-ray films.ResultsAll incisions healed by first intention. Sixteen patients were followed up 18-69 months (mean, 40.6 months). Intraoperative ulnar nerve injury occurred in 2 cases, and healed after symptomatic treatment. At last follow-up, the MEPS score was 55-100 (mean, 90.3). The results were excellent in 11 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 81.3%. The VAS score was 0-2 (mean, 0.4). X-ray reexamination showed that no polyethylene wear, prosthesis loosening and fracture, abnormal prosthesis position, periprosthetic fracture occurred during the follow-up period, and the prosthesis survival rate was 100%. Heterotopic ossification occurred in 2 and 3 months after operation in 2 cases, respectively.ConclusionThe triceps on approach for TEA are satisfactory for distal humerus fracture, osteoarthritis, and rheumatoid arthritis.
Rheumatoid arthritis (RA) is a chronic autoimmune disease remarkably characterized by synovitis of joints, whose pathogenesis is complicated and not yet fully elucidated. A variety of cells, cytokines and intercellular signaling pathways are involved in the occurrence and development of RA. The mitogen activation protein kinase (MAPK) signaling pathway is closely related to the pathogenesis of RA, and plays an important role in the formation of pannus, synovitis, and bone destruction. This paper reviews the research progress of MAPK signaling pathway in RA from the aspects of the interaction of MAPK signaling pathway with a variety of key cells and cytokines in the pathogenesis of RA, in order to provide a direction and theoretical basis for anti-RA drug therapy research.
Rheumatoid arthritis (RA) is one of the most common immune-mediated diseases, and the interaction between the intestinal microbiota and the patient’s immune system may play a role in the occurrence and development of RA. Methotrexate (MTX), as a first-line drug for the treatment of RA, can be directly and indirectly influenced by intestinal microbiota and its enzyme products to affect the bioavailability, clinical efficacy, and toxicity of the drug. Therefore, it is crucial to understand the mechanism by which intestinal microbiota affects RA and the impact of intestinal microbiota on the efficacy of MTX. This article provides a review of the mechanisms by which intestinal microbiota may contribute to the pathogenesis of RA, as well as the role and impact of intestinal microbiota in MTX drug metabolism and treatment response.