曲安奈德联合甲氨喋呤关节腔注射治疗类风湿关节炎

目的探讨联合使用甲氨喋呤(MTX)和曲安奈德(TA)关节腔注射治疗类风湿关节炎(RA)的疗效。方法选择2006年1月-2007年4月我院门诊对称性腕或膝关节炎的RA患者37例。选择一对炎症程度相当的膝或腕关节,随机确定一侧,以曲安奈德针(TA)1mL:40mg溶解MTX针(MTX)5mg混匀后关节腔注射(TM组)。对侧作为对照,以相同剂量曲安奈德针关节腔注射(TA组),整体治疗不变,继续按原来方法服用NSAIDs及DMARDs治疗。分别于注射后第1个月、3个月、6个月末观察注射关节的肿胀数、疼痛数、压痛数及相应指数。结果TM组与TA组关节腔注射后,肿胀关节明显减少,而不同时间点两组间差异均有统计学意义(P<0.01)。随访6个月,两组均未发现明显不良反应。结论曲安奈德针联合MTX针关节腔注射治疗类风湿关节炎,其消炎、止痛、消肿和改善患者关节功能的疗效优于单用曲安奈德针关节腔注射,可显著减少复发机会,延迟复发时间,是类风湿关节炎有效的控制方法之一。

Effect of intra-articular injection of triamcinolone acetonide and methotrexate on rheumatoid arthritis

Objective To discuss the therapeutic effect of intra-articular injection of methotrexate(MTX)and Triamcinolone acetonide(TA)on rheumatoid arthritis(RA).Methods 37 patients with active RA and a similar degree of inflammation in two symmetrical joints(wrist,elbow,or knee)were enrolled.The symmetry was assessed by both clinical examination and synovial fluid analysis.TA 40 mg was injected intra-articularly to the target joints(a side of joint)intra-articular:TA group;and the combination of TA 40 mg with MTX 5 mg were injected to the contralateral joint intra-articularly:TM group.DMARDs and NSAIDs therapy continued.The swollen joint count(SJC),pain joint count,tender joint count(TJC)and related indexes were recorded.Results The SJC decreased after intra-articular injection,and there were significant differences between the SJC of 2 groups(P<0.01)at different time points.No serious adverse event was observed in 2 groups.Conclusion MTX-TA is more effective,and the method should be considered the better choice for intra-articular treatment of RA.