Changes of biochemical indexes and joint function in the patients with rheumatoid arthritis after total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2013.39.006

Abstract

Abstract:

BACKGROUND: There are many reports on the clinical effect of total knee arthroplasty in the treatment of advanced rheumatoid arthritis, but the reports on the effect of total knee arthroplasty on the disease activity in patients with rheumatoid arthritis are rare. Therefore, the more clinical evidences are needed for supporting.
OBJECTIVE: To explore the effect of total knee arthroplasty on disease activity in patients with rheumatoid arthritis.
METHODS: 109 patients with rheumatoid arthritis were included; 48 cases in the replacement group, and received total knee arthroplasty combined with internal medicine medications; the 61 cases in the drug treatment group were treated with simple internal medicine medications. The rheumatoid factor, blood sedimentation rate and C-reactive protein levels of the patients in two groups were measured before treatment, 1 and 2 years after treatment, and the Ishikawa joint function scoring criteria was used to assess the functions.
RESULTS AND CONCLUSION: There were no significant differences in the rheumatoid factor, blood sedimentation rate and C-reactive protein levels between two groups before treatment (P > 0.05). At 1 and
2 years after treatment, the indicators in the drug treatment group were higher than those in the replacement group (P < 0.05); the indicators in the two groups at 2 years after treatment were significantly lower than those before treatment (P < 0.05). The rheumatoid arthritis symptom scores of the affected joints of the patients in two groups were significantly improved, especially the pain, swell and subjective attitudes, and the replacement group was better than the drug treatment group (P < 0.05). The total knee arthroplasty can affect the disease activity of rheumatoid arthritis in short-term, and the effect of total knee arthroplasty is better than simple drug treatment.

Key words: arthroplasty, replacement, knee, arthritis, rheumatoid, rheumatoid factor, blood sedimentation, C-reactive protein

CLC Number:

R318

Wu Li-xin, Zhang Hai-bin, Li Xiao-hui, Ren Kai-jing, Yang Guo-yue. Changes of biochemical indexes and joint function in the patients with rheumatoid arthritis after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(39): 6896-6901.

Figures/Tables 3

类风湿因子变化：治疗前置换组平均为311.88 IU/mL，药物治疗组平均为310.36 IU/mL，组间比较差异无显著性意义(t=0.053，P > 0.05)。治疗后2年置换组平均为207.59 IU/mL，药物治疗组平均为271.74 IU/mL，药物治疗组显著高于置换组(t = 3.101，P=0.02)。2组治疗后2年类风湿因子水平均显著低于治疗前(P < 0.05)。血沉变化：治疗前置换组平均为57.25 mm/h；药物治疗组平均为56.27 mm/h，2组差异无显著性意义(t= 0.271，P > 0.05)。治疗后2年置换组平均为38.28 mm/h，药物治疗组平均为46.00 mm/h，药物治疗组显著高于置换组(t=-3.039，P=0.03)。2组治疗后2年血沉均显著低于治疗前(P < 0.05)。 C-反应蛋白变化：治疗前置换组平均为53.48 mg/L，药物治疗组平均为53.06 mg/L，2组差异无显著性意义(t= 0.112，P > 0.05)。治疗后2年置换组平均为35.36 mg/L，药物治疗组平均为41.79 mg/L，药物治疗组显著高于置换组(t=2.169，P=0.032)。2组治疗后2年C-反应蛋白水平均显著低于治疗前(P < 0.05)。 2.4 临床疗效分别于治疗前和治疗后1，2年对全身受累关节进行评定，评定方法采用Ishikawa关节临床评分标准。随访结果显示，置换组治疗前平均6.55分，治疗后1年平均8.71分，治疗后2年平均8.4分，其中优8例(18%)，良16例(36%)，可18例(40%)，差3例(7%)。药物治疗组治疗前平均6.46分，治疗后1年平均7.38分，治疗后2年平均7.91分，其中优8例(16%)，良19例(36%)，可22例(41%)，差4例(7%)。治疗后受累关节类风湿关节炎症状的显著改善主要表现在疼痛、肿胀和主观感受方面，见表4。 2.5 不良事件置换组1例患者置换后浅部感染，经过换药等处理治愈；另有1例患者出现下肢深静脉(腘静脉)血栓，经过固定、抗凝等处理，3周后血栓静止后开始功能锻炼，因屈膝功能恢复不满意，但经过锻炼，置换后6个月膝关节屈曲达到100°。 "

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