阿达木单抗治疗复杂银屑病关节炎

笔者于2011年5月收治复杂银屑病关节炎(PsA)1例,应用阿达木单抗—修美乐(生物制剂,全球首个被批准的TNF-α全人源单克隆抗体药)进行治疗,快速有效。现报告如下。     

利妥昔单抗治疗类风湿关节炎的Meta分析

目的:系统评价利妥昔单抗(RTX)治疗类风湿关节炎的临床疗效及安全性.方法:在Pubmed、中国知网、万方数据、维普数据库中以“利妥昔单抗”、“rituximab”、“类风湿关节炎”等为检索词检索相关文献,检索时间从建库至2016年4月.收集有关利妥昔单抗治疗类风湿关节炎的随机临床对照研究,对其进行质量评价,使用RevMan 5.3软件对纳入研究进行Meta分析.结果:最终纳入5个随机对照试验,共2 727例研究对象,其中1 000mg RTX试验组1 240例,500 mg RTX试验组548例,安慰剂组939例;4个临床试验随访了第24周的情况,1个临床试验随访了第52周情况.Meta分析结果显示:①给予利妥昔单抗治疗类风湿关节炎24周疗效优于安慰剂组,差异有显著性[OR=2.78,95％CI (2.26,3.34),P＜0.000 01];②安全性方面:利妥昔单抗组的不良反应与安慰剂组比较差异无显著性[500 mg RTX组:OR=0.91,95％CI (0.67,1.25),P=0.56;1 000 mg RTX组:OR=1.00,95％CI(0.80,1.26),P=0.97].结论:利妥昔单抗治疗类风湿关节炎有效,不良反应与安慰剂组比较差异无显著性.     

来氟米特治疗类风湿关节炎患者的护理

对48例住院期间服用来氟米特（LEF）的类风湿关节炎（RA）患者进行心理护理、不良反应的护理以及出院指导等护理干预。结果48例患者都能够积极配合用药，学会自我保健，无严重的不良反应，关节功能得到改善。提示通过护理干预可使服用LEF的RA患者减轻不良反应，提高生活质量，增强对治疗的信心。     

来氟米特治疗类风湿关节炎患者的护理

对48例住院期间服用来氟米特(LEF)的类风湿关节炎(RA)患者进行心理护理、不良反应的护理以及出院指导等护理干预.结果48例患者都能够积极配合用药,学会自我保健,无严重的不良反应,关节功能得到改善.提示通过护理干预可使服用LEF的RA患者减轻不良反应,提高生活质量,增强对治疗的信心.     

活动期类风湿关节炎患者关节功能锻炼的延续护理

目的探讨延续护理干预用于活动期类风湿关节炎患者关节功能锻炼的效果。方法将39例住院活动期类风湿关节炎患者按照时间顺序分为干预组(19例)和对照组(20例)。两组住院期间接受相同的关节功能锻炼方法及健康教育指导,对照组出院后给予常规护理指导,干预组由延续护理小组利用微信平台密切了解患者关节疼痛情况,指导规范服药,根据病情进行关节功能锻炼并观察效果。结果干预6周后,两组压痛和肿胀关节数、晨僵时间、机体功能评估量表(HAQ)、疼痛评分、红细胞沉降率、28个关节疾病活动度评分(DAS28)比较,差异有统计学意义(P0.05,P0.01)。结论延续护理可提高类风湿关节炎患者关节锻炼的效果。     

系统性红斑狼疮重叠类风湿关节炎的护理体会

报告1例系统性红斑狼疮(SLE)与类风湿关节炎(RA)重叠,又称Rhupus综合征患者的护理经验.该病例临床罕见,病情特殊,在护理上实施针对的措施、统筹兼顾、综合护理,取得较好的效果.     

类风湿关节炎肾损害

类风湿关节炎肾损害包括原发性肾损害和继发性肾损害 ,前者包括系膜增生性肾小球肾炎、膜性肾病、膜增生性肾炎和基底膜变薄等 ,后者包括肾血管炎、肾淀粉样变、药物性肾损害 (继发于非甾体抗炎药、青霉胺、金制剂、环孢素A及氨甲喋啶的肾损害 )、肾结石等。本文综述类风湿关节炎肾损害的发病机理、病理及临床表现、治疗进展及预后等。     

浅谈中医治疗类风湿关节炎60例

探讨中医药治疗类风湿关节炎的治疗方法和临床疗效,辨别类风湿关节炎的基本证型及主要症状,通过对比说明中医药治疗类风湿关节炎的优势及其不可替代的作用.     

肿瘤坏死因子受体-抗体融合蛋白治疗类风湿关节炎患者的护理

对30例类风湿关节炎(RA)患者采用肿瘤坏死因子受体-抗体融合蛋白(TNFR:FC)进行治疗,并加强心理护理、用药护理及不良反应的护理.结果 显效24例,有效4例,总有效率93.3%.提示护理干预可减轻RA患者药物不良反应,提高治疗舒适度,从而提高疗效.     

Visceral leishmaniasis and macrophagic activation syndrome in a patient with rheumatoid arthritis under treatment with adalimumab

BackgroundVisceral leishmaniasis is a protozoan infection usually asymptomatic, but can progress to fatal disease in immunocompromised hosts, especially in HIV patients. Visceral leishmaniasis is rare among patients under immunosuppressive therapies, and even more among patients under anti-TNF-α treatment, where only four cases have been described.Objective1) To describe a patient with rheumatoid arthritis receiving adalimumab who developed fever, pancytopenia, splenomegaly, and extreme hyperferritinemia. 2) To perform a review of the published cases of visceral leishmaniasis and anti-TNF-α therapy, and cases of coexisting leishmaniasis and macrophagic activation syndrome by search in PubMed (period 1991–2008).ResultsVisceral leishmaniasis was established by bone marrow aspiration, and although there was no histological confirmation, according to HLH-2004 criteria, a secondary macrophagic activation syndrome was established. The patient had a favourable outcome.ConclusionWe report herein the fifth case of visceral leishmaniasis in a patient under TNF-α therapy, and the first one, to our knowledge, presenting a consequent secondary macrophagic activation syndrome.     

Gene therapy for patients with rheumatoid arthritis

Gene therapy seeks either to supply a missing or dysfunctional gene or to ensure continuous long-lasting production of a therapeutic protein. Rheumatoid arthritis is a candidate for gene therapy, as the mechanisms leading to joint inflammation and destruction have been partly elucidated. Nevertheless, several crucial questions need to be addressed. Knowledge of the underlying pathophysiological mechanisms is needed to guide selection of the candidate gene. In the light of current data, TNF and IL-1 antagonists are generating interest. A choice must be made between a viral vector (adenovirus, retrovirus, adeno-associated virus) and a nonviral vector (naked DNA, administered by electrotransfer or in liposomes). Finally, the relative merits of intraarticular and systemic administration need to be considered. Safety is a primary concern. The transgene and/or vector may induce adverse effects. For instance, a transgene inserted within the host genome (when a retroviral vector is used) may induce a mutation. A number of vectors and transgenes induce immune responses. Numerous studies are ongoing to investigate the safety and efficacy of gene therapy strategies in experimental models of rheumatoid arthritis. These studies will have to be completed before further clinical trials of gene therapy in rheumatoid arthritis are considered.     

Superoxide dismutase and hyperbaric oxygen therapy of the patient with rheumatoid arthritis

Cu, Zn-SOD values were measured by enzyme immunoassay in the synovial fluid, leukocytes in the synovial fluid, synovial membrane, and leukocytes in blood of the patients with rheumatoid arthritis. SOD activity, lipoperoxide value in serum, ESR, and Lansbury's index of the patients with rheumatoid arthritis under hyperbaric oxygen (HBO) therapy were also investigated. SOD values of synovial fluid and of leukocytes in synovial fluid from rheumatoid arthritis group were found to be higher than those from osteoarthritis group. No significant difference was found the SOD values in leukocytes of blood and synovial membrane between two groups. In the patients with rheumatoid arthritis under HBO therapy the SOD activity was increased, whereas lipoperoxide values was decreased. Furthermore, ESR and Lansbury's index showed a remarkable recovery. These results suggest that HBO therapy may be an effective treatment for the patients with rheumatoid arthritis.     

Septic arthritis in a patient with juvenile rheumatoid arthritis

The acute flare of joint inflammation in the child with known juvenile rheumatoid arthritis causes concern primarily regarding the need for additional or modified medical treatment. Acute joint inflammation in an otherwise healthy child creates concern regarding the existence of joint infection. In the early phase of disease, the clinical findings and symptoms of an inflamed joint attributable to juvenile rheumatoid arthritis or infection may be similar and difficult to differentiate from the other. Juvenile rheumatoid arthritis usually is well controlled by medical interventions, however, the initiation of specific treatment is more urgent in children with joint sepsis. The following case report is presented to emphasize the difficulty in evaluation of patients with known juvenile rheumatoid arthritis and coexistent septic arthritis, and to discuss the methods used to differentiate between the two conditions.     

Perioperative medication management for the patient with rheumatoid arthritis

The treatment of rheumatoid arthritis has improved dramatically in recent years with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thus requiring surgical intervention to reduce pain and improve function. In these cases, the orthopaedic surgeon frequently encounters patients on a drug regimen consisting of nonsteroidal anti-inflammatory drugs, glucocorticoids, methotrexate, and biologic agents (disease-modifying antirheumatic drugs). Consultation with a rheumatologist is recommended, but the surgeon also should be aware of these medications that could potentially affect surgical outcome. Prudent perioperative management of these drugs is required to optimize surgical outcome. A balance must be struck between minimizing potential surgical complications and maintaining disease control to facilitate postoperative rehabilitation of patients with rheumatoid arthritis.