局部关节腔注射激素治疗类风湿关节炎的临床研究

类风湿关节炎（RA）是一种以侵犯关节为主的慢性全身性炎症性疾病。在外周关节病变中。慢性迁延性滑膜炎及反复发作是RA致残的主要原因之一。目前对RA关节病变的治疗尚缺乏有效手段，通常使用非甾体抗炎药并联合应用慢作用药。对控制症状、缓解病情有一定疗效。但慢作用药起效慢，在其发挥作用前，迁延性滑膜炎导致病情发展，最终关节强直、功能丧失以至关节置换。严重影响患者生活质量。本研究采用对RA关节病变患者施行局部关节腔注射激素并联合药物治疗。与单纯药物治疗对照，进行为期两年的随访，以探讨局部激素治疗的有效性及安全性。     

金诺芬和甲氨喋呤联合治疗类风湿关节炎

金诺芬和甲氨喋呤联合治疗类风湿关节炎袁国华，王轶，施桂英近年来随着对类风湿关节炎（ＲＡ）病程的进一步认识，治疗ＲＡ的策略发生了极大的变化，传统的金字塔治疗模式正在被早期应用改变病情药物（ＤＭＡＲＤ）的新策略所取代。但单一ＤＭＡＲＤ诱导的缓解率并不令人...     

透明质酸、曲安奈德关节腔内注射及双氯芬酸口服治疗膝骨关节炎对比观察

2005年7月-2007年7月,我们分别采用透明质酸、曲安奈德关节腔内注射及双氯芬酸口服治疗膝骨关节炎各30例,并进行了对比观察。现报告如下。     

依那西普、甲氨蝶呤关节腔注射治疗膝关节炎的超声评价

<正>膝关节类风湿性滑膜炎是一种以膝关节滑膜炎为特征的慢性全身性自身免疫性疾病,主要病理改变是滑膜绒毛充血、水肿及增厚,滑膜内小血管扩张,滑膜炎性细胞浸润产生大量关节腔积液〔1,2〕。超声作为诊断早期滑膜炎的一种方法能够准确判断关节内是否出现液体。高频超声在检查软组织时具有很高的分辨力,特别是在检测含有液体的软组织细微结构时效果更佳〔3〕。但是目前多普勒超声评价药物治疗类风湿滑膜增生的疗效应用较少,而且评价药物对类风湿滑膜增生的疗效体     

玻璃酸钠联合曲安奈德治疗中老年膝关节炎的疗效

<正>老年膝关节炎是临床中十分的老年多发性疾病之一,是一种以关节软骨变性、破坏以及骨质增生为临床特征的一种慢性关节病,其主要临床表现为膝关节疼痛、肿胀或膝关节积液等,晚期则会导致膝关节变形,功能受限,甚至导致患者出现膝关节行走障碍等,对老年患者的生活质量产生较为严重的消极影响〔1〕。本文拟深入探讨玻璃酸钠联合曲安奈德对中老年膝关节炎患者的临床疗效。1资料与方法1.1一般资料我院2011年4月至2013年4月期间共收治     

曲安奈德皮损内注射联合放疗治疗瘢痕疙瘩的疗效观察

目的观察曲安奈德皮损内注射联合放疗治疗瘢痕疙瘩的临床疗效。方法将60例瘢痕疙瘩患者随机分为两组,A组采用曲安奈德40~80 mg皮损内注射,每4周1次,至瘢痕疙瘩变软、变平;最后一次注射后1周内行局部6 M eV电子线外照射,共1 600~2 000 cGy;B组行单纯曲安奈德皮损内注射,方法同A组,瘢痕疙瘩变平、变软后加强1次。结果 A、B组总有效率分别为87.23%、79.59%,治愈率分别为55.32%、34.69%,两组治愈率比较有统计学差异（P〈0.05）。结论曲安奈德皮损内注射联合放疗治疗瘢痕疙瘩疗效确切,其疗效优于单纯曲安奈德皮损内注射治疗。     

类风湿关节炎滑膜巨噬细胞来源的研究

目的　了解类风湿关节炎 (RA)滑膜巨噬细胞的来源。方法　采用免疫组化LSAB法对 2 6例RA滑膜 ,2 0例非RA滑膜及 7例正常滑膜进行连续切片CD6 8和PCNA染色。结果　正常滑膜衬里层细胞几乎全部CD6 8阳性而PCNA阴性 ,衬里下层CD6 8和PCNA阳性细胞极少 ;RA滑膜衬里层和衬里下层PCNA阳性细胞数较非RA滑膜明显增多 (P <0 0 5 ) ,衬里层滑膜细胞大部分CD6 8阳性 ,衬里下层CD6 8阳性细胞数较非RA滑膜明显增多 (P <0 0 5 ) ,并且衬里层和衬里下层部分CD6 8阳性的细胞PCNA也阳性。结论　RA滑膜增多的A型巨噬样滑膜细胞和衬里下层的巨噬细胞都有局部增生 ,表明RA滑膜衬里下层聚集的巨噬细胞除来源于血液中的单核细胞趋化转移外 ,还与巨噬细胞在炎症局部增生有关。     

曲安奈德球内注射治疗黄斑水肿效果观察（附25例报告）

目的观察曲安奈德球内注射治疗黄斑水肿的效果。方法50例黄斑水肿患者随机分为常规组（常规药物治疗＋激光治疗）和观察组（曲安奈德球内注射治疗）,各25例。比较两组视力、黄斑厚度、治愈率。结果观察组治疗后视力为0．66±0．21、黄斑中央厚度（320±63）μm,治愈率为92％;常规组分别为0．45±0．06、（400±21）μm和72％（P均〈0．05）。结论与常规治疗比较,曲安奈德球内注射治疗黄斑水肿疗效可靠。     

玻璃体腔内注射曲安奈德治疗黄斑水肿并发症的临床分析

目的探讨玻璃体腔内注射曲安奈德(TA)治疗黄斑水肿后出现的各种并发症的发病率及特点。方法回顾性收集经眼底、萤光素眼底血管造影(FFA)及光学相干断层扫描(OCT)检查诊断为视网膜静脉阻塞所致的黄斑水肿并接受玻璃体腔内注射TA的37例老年及37例中年患者的临床资料,统计术后各类并发症的发病率。结果(1)老年组术后发生高眼压,非感染性眼内炎,结膜溃疡及黄斑裂孔者明显多于中年组。房水闪辉,赋形剂残留在两组中发病率无明显差异。结论TA玻璃体腔内注射更适合治疗视网膜静脉阻塞所致的老年性黄斑水肿。     

高频超声在诊断类风湿关节炎患者指关节病变中的应用

目的探讨高频超声在诊断类风湿关节炎（RA）患者手指关节病变中的价值。方法RA患者42例，健康志愿者40名，分别应用高频超声观察双手掌指关节和近端指间关节，测量滑膜厚度，检测有无肌腱、关节腔和骨质病变。结果RA患者79％（33／42）存在滑膜增生，18例患者可见肌腱病变，5例病人可见关节腔积液，5例患者可见骨质破坏，3例患者可见关节融合。病程少于5年的病例主要表现为滑膜增生，而骨质破坏、关节融合的病例病程多在10年以上。结论高频超声可应用于RA患者手指关节病变的诊断。     

Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis

OBJECTIVE: To compare patients with juvenile rheumatoid arthritis (JRA) injected with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA) with respect to time to relapse. METHODS: This was a retrospective chart review of 85 patients: 51 patients with JRA who had received a joint injection with TH during the period June 2000-April 2001 and 48 patients who had received a joint injection with TA during the period May 2001-March 2002 who were followed for a minimum of 15 months, after an intraarticular steroid injection. RESULTS: The primary endpoint variable for the study was the time to relapse of the arthritis in the affected joint following an intraarticular injection. A total of 227 joints were injected, 114 with TH and 113 with TA. In the TH group the mean time to relapse (+/- SE) was 10.14 +/- 0.49 months compared to the TA group at 7.75 +/- 0.49 months (p < 0.0001) using the log-rank test. A proportional hazards (Cox) regression analysis revealed no statistical association between sex, duration of illness, or type of arthritis and relapse time. An analysis was performed on the first intraarticular injection for each patient, with the average time to relapse for all joints injected of 10.36 +/- 0.72 months for TH compared to 8.45 +/- 0.78 months for TA (p < 0.02). A further analysis of the first knee injections showed a relapse time in the TH group of 11.11 +/- 0.81 months compared to 7.95 +/- 0.95 months for TA (p < 0.008). CONCLUSION: TH offers an advantage to TA, as there is a longer duration of action leading to an improved prolonged response rate in weight-bearing joints, particularly the knees. The results suggest that TH should be the intraarticular steroid of choice, particularly for the knee joint, in patients with JRA.     

Outcomes of intraarticular triamcinolone acetonide injection in children with non-systemic juvenile idiopathic arthritis

Clinical Rheumatology - The objectives were to explore the response to intraarticular triamcinolone acetonide (TA) injection in children with non-systemic juvenile idiopathic arthritis (JIA) and...     

Hepatic ultrastructure after methotrexate therapy for rheumatoid arthritis

Twenty-six patients receiving long-term oral methotrexate (MTX) therapy for rheumatoid arthritis (24 patients) or psoriasis (2 patients) were prospectively evaluated for alterations in liver morphology by light microscopy, electron microscopy, and immunofluorescence microscopy. Although only 4 MTX-treated patients had light microscopic evidence of mild fibrosis, all had evidence of collagen deposition in the space of Disse near Ito cells and changes in hepatocyte lysosomes on electron microscopy. These findings were absent from control livers. Fibrinogen, fibronectin, and type IV collagen were identified by immunofluorescence in both MTX-treated patients and controls. We conclude that long-term MTX therapy for rheumatoid arthritis is associated with alterations in hepatic ultrastructure, including collagen deposition in the space of Disse and changes in hepatocyte lysosomes.     

Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis

OBJECTIVE: To compare the efficacy and safety of intra-articular triamcinolone hexacetonide (TH) and triamcinolone acetonide (TA) in children with oligoarticular juvenile idiopathic arthritis (JIA). METHODS: One hundred and thirty joints of 85 patients undergoing intra-articular injections were randomly treated with either TH or TA depending on the availability of the drug. The efficacy of both treatments was evaluated prospectively in a blinded fashion. A good response was defined as a decrease in the articular score of > or =60% from baseline. Clinical, laboratory and immunological variables were noted in order to examine possible factors, other than treatment, predictive of the result. RESULTS: Seventy injections were performed using TH and 60 with TA. The two groups were comparable for clinical, immunological and laboratory characteristics. The rate of response was significantly higher with TH than with TA: 81.4% vs 53.3% (P = 0.001) at 6 months, 67.1 vs 43.3% (P = 0.006) at 12 months, and 60 vs 33.3% (P = 0.002) at 24 months. CONCLUSION: At comparable doses TH appeared to be much more effective than TA for intra-articular use, in both short- and long-term follow-up. This result was not affected by disease duration or degree of local and systemic inflammation.     

The use of methotrexate in rheumatoid arthritis

OBJECTIVE: To address the long-term efficacy and toxicity issues related to methotrexate (MTX) and compare it with other disease-modifying antirheumatic drugs (DMARDs). METHODS: Review of the international literature on the clinical use of MTX in rheumatoid arthritis (RA) disease. RESULTS: MTX has emerged as a relatively safe and effective treatment for RA that compares favorably with other therapies, particularly because of its considerably longer median drug survival. The toxicity profile of MTX is well established and includes serious and sometimes fatal liver disease, pneumonitis, and cytopenias. Hence, regular and careful monitoring of patients taking MTX is essential, particularly when MTX is combined with other DMARDs. Folate supplementation can reduce some of the most common side effects of MTX, but it has not yet been established whether this translates into a reduced risk of serious disease. Another potential approach to reducing the toxicity of MTX is therapeutic drug monitoring and dose individualization. However, correlations between pharmacokinetics and clinical response have been addressed in only a few studies and with conflicting results. CONCLUSIONS: MTX is an effective DMARD with a relatively safe profile compared with other therapies. Folate supplementation can significantly reduce the risk of MTX toxicity. Finally, it is essential that patients be monitored carefully to reduce the potential serious toxicities of MTX.     

Elevation of intraocular pressure after intravitreal injection of triamcinolone acetonide in Taiwanese patients

The purpose of this study was to investigate the incidence and timing of elevation in intraocular pressure (IOP) after intravitreal injection of triamcinolone acetonide (IVTA). This was a retrospective observational case series that included 52 eyes from 52 patients. All patients received intravitreal injection with 4 mg of triamcinolone acetonide. Significant IOP elevation was defined as pressure greater than 21 mmHg. There were 26 males and 26 females included in this study. The mean age was 59.4 years. The mean IOP at baseline and postoperative mean highest IOP were 14.6 mmHg and 21.5 mmHg, respectively. There were 19 (36.5%) patients who experienced significant IOP elevation at a mean of 26.0 days after IVTA. IOP was well-controlled by topical antiglaucoma medication in 17 of these 19 patients. IOP elevation after intravitreal injection with 4 mg of triamcinolone acetonide is not a rare finding. This phenomenon usually starts approximately 1 month after IVTA. Patients considering this treatment should be fully informed of this known adverse effect.     

The methotrexate therapeutic response in rheumatoid arthritis

OBJECTIVE: Methotrexate (MTX) is used frequently as a disease modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA), and patients tend to continue taking this drug for longer periods than alternative single agents. The shape of the therapeutic response beyond one or 2 years, however, has not been fully studied. We examined the properties of the pure MTX "therapeutic segment," that period that begins with start of MTX and terminates when MTX is discontinued or another DMARD is added, by observational study. METHODS: We studied new MTX starts for the period 1988 through 1996 for 437 patients from a parent cohort of 4253 patients. Patients were drawn from 8 Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) data centers: 2 community based populations; 2 private rheumatological practices; 2 university referral practices; and 2 university clinics for underserved minority urban populations. Health Assessment Questionnaire (HAQ) Disability Index scores (0-3) were obtained prospectively each 6 months. RESULTS: At MTX start, patients had relatively long average disease duration of 16.7 years, and had moderately severe disability, with an initial HAQ mean disability score of 1.48. Over the 10 year period examined in the parent cohort of 4253 patients (and thus irrespective of therapy), the prevalence of MTX use rose from 19% to 45%, while mean HAQ disability declined from 1.34 to 1.11. This correspondence is consistent with an accrual of benefits from more frequent use of MTX and other DMARD over this period. The MTX therapeutic segment revealed a distinct shape. HAQ-Disability Index values began at 1.48 at baseline and declined to a maximal improvement of 1.23 at 30 months. This long period to maximum benefit may have been partly driven by a slow titration upward to an optimal dosage. After 42 months, disability for this population began to re-progress and reached 1.39 at 84 months, still below the pretreatment baseline. Re-progression to baseline was about 8 or more years. Cumulative disability averted with MTX treatment for this population was roughly 1.30 disability-unit-years. CONCLUSION: MTX treatment of RA in practice differs substantially from common perception and appears suboptimal by being too little, too late, and too long to treatment change. A modification of the "sawtooth strategy" in which the disease is "ratcheted down" by change of MTX therapy at 3 years or when re-progression has proceeded halfway to baseline, rather than waiting for return to baseline, is suggested by these data. Also suggested is the need for more rapid upward dosage titration and longer maintenance of an optimal or highest tolerated dosage. "Therapeutic segment" data provide insights into strategic approaches to management of RA since they allow estimation of population aggregate properties such as time to maximum benefit and the time to return to baseline.