Rheumatoid Arthritis(RA)is an autoimmune disorder that hinders the normal functioning of bones and joints and reduces the quality of human life.Every year,millions of people are diagnosed with RA worldwide,particularl...Rheumatoid Arthritis(RA)is an autoimmune disorder that hinders the normal functioning of bones and joints and reduces the quality of human life.Every year,millions of people are diagnosed with RA worldwide,particularly among elderly individuals and women.Therefore,there is a global need to develop new biomaterials,medicines and therapeutic methods for treating RA.This will improve the Healthcare Access and Quality Index and also relieve administrative and financial burdens on healthcare service providers at a global scale.Hydrogels are soft and cross-linked polymeric materials that can store a chunk of fluids,drugs and biomolecules for hydration and therapeutic applications.Hydrogels are biocompatible and exhibit excellent mechanical properties,such as providing elastic cushions to articulating joints by mimicking the natural synovial fluid.Hence,hydrogels create a natural biological environment within the synovial cavity to reduce autoimmune reactions and friction.Hydrogels also lubricate the articulating joint surfaces to prevent degradation of synovial surfaces of bones and cartilage,thus exhibiting high potential for treating RA.This work reviews the progress in injectable and implantable hydrogels,synthesis methods,types of drugs,advantages and challenges.Additionally,it discusses the role of hydrogels in targeted drug delivery,mechanistic behaviour and tribological performance for RA treatment.展开更多
In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) incr...In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.展开更多
Objective: The aim of this study was to evaluate the efficacy of digital panoramic radiographs using the JLA view pro-gram in cases of rheumatoid arthritis and compare them to CT scans of the patients. Methods: 40 pat...Objective: The aim of this study was to evaluate the efficacy of digital panoramic radiographs using the JLA view pro-gram in cases of rheumatoid arthritis and compare them to CT scans of the patients. Methods: 40 patients with known condition of RA and clinical symptoms in the TMJ were selected for the study. Radiological evaluation included a panoramic radiograph of the TMJs that was taken and a computer tomography of the joints. In the panoramic radio-graphs taken, isolation of the TMJs was done using the JLA view program, while in the CT scans of the patients, all scans were taken with closed mouth, with a distance of 0.5 mm per slice. The parameters examined were: 1) Bony changes of the condyle;2) The position of the condyle in the mandibular fossa;3) The joint space;4) Bony changes of mandibular fossa. Results: There were no statistically significant differences found between the two observers or be-tween the two joints of the same patient [right and left] on the panoramic radiographs. For the case of CT scans there were significant differences between the joint space of right and left joints, while in the ANOVA performed differences were found for the evaluation of the bony changes of the condyle. Conclusion: There were no significant differences between the two radiographic methods selected and therefore when a proper simple radiograph is taken and well evalu-ated, the conclusions drawn from it are well based and there is no need for further展开更多
Joint deformity and dysfunction are common and serious complications in the late stage of rheumatoid arthritis,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)believes that join...Joint deformity and dysfunction are common and serious complications in the late stage of rheumatoid arthritis,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)believes that joint deformity and dysfunction in some patients with rheumatoid arthritis are closely related to the apraxia of meridians and tendons due to enduring illness.Based on the theory of meridians and tendons circulation,using the local and nearby therapeutic effect of acupoints as the treatment method in clinical practice,we conducted penetration needling of Houxi,Baxie,Wailaogong as well as Ashi points of interphalangeal joints of both hands through bilateral Sanjian,and used the uniform reinforcing-reducing method to soothe tendons and meridians,thus effectively improving the dysfunction of deformed joints.展开更多
Background: It has been accepted amongst rheumatologists that rheumatoid arthritis (RA) does not involve the facet joints (FJs) of the spine;nevertheless, the issue is still under debate. Objective: To compare the pre...Background: It has been accepted amongst rheumatologists that rheumatoid arthritis (RA) does not involve the facet joints (FJs) of the spine;nevertheless, the issue is still under debate. Objective: To compare the prevalence of FJs’ changes between patients with RA and age- and sex-matched peers. Methods: CT scans of 34 patients with RA suffering from low back pain (LBP) were compared with 70 age- and sex-matched controls (individuals without RA, suffering from LBP) in a case-control study. The degenerative changes in the FJs were evaluated (i.e., joint space narrowing, marginal osteophytes, articular process hypertrophy, subchondral sclerosis, inter-joint vacuum phenomenon, and subchondral cysts), in addition to the marginal erosions, the most characteristic feature of joint change in RA. Disease activity characteristics (CRP, ESR, DAS-28, SDAI, and CDAI), duration of RA, age, and sex were obtained from patients’ clinical charts. Results: The prevalence of FJs’ changes in patients with RA and age- and sex-matched controls were not significantly different at any spinal level or in a total L1-S1 score. Marginal erosions, a characteristic feature of joint changes in RA, were not found in any of our RA subjects. No difference was found in disease parameters and markers in individuals with RA with affected FJs and those without. The occurrence of FJs’ changes amongst subjects with RA demonstrated no correlation with disease duration and activity. Conclusions: FJs of the lumbar spine are not involved in the inflammatory process of RA, and their LBP is not due to inflammation in FJs of the spine.展开更多
Background: Rheumatoid arthritis is a form of autoimmune disease characterized by synovitis that can ultimately cause joint deformities and impaired functioning. The cartilage destruction is one of the most important ...Background: Rheumatoid arthritis is a form of autoimmune disease characterized by synovitis that can ultimately cause joint deformities and impaired functioning. The cartilage destruction is one of the most important indicators for diagnosis and treatment of rheumatoid arthritis, and it is radiographically manifested as joint space narrowing. Issue: In the literature, the joint space narrowing progression between a baseline and its follow-up finger joint images can be quantified by using image registration algorithm. We found that the inconsistencies of joint angles may lead to characteristic mismatches and thus severely affect the accuracy of joint space narrowing quantifications. Methods: In this work, we introduce a rotation invariant phase only correlation in joint space narrowing quantification for the joint angle correction. Further, we propose a confidence index to quantify the quantification reliability of phase only correlation based on phase dispersion in phase difference spectrum. Conclusion: In our clinical experiments, the proposed quantification method can effectively overcome and manage the mismatch due to the inconsistency of joint angles. Additionally, the confidence index shows a high consistency with the joint space narrowing progression examinations manually done by a trained radiologist and one radiological technologist.展开更多
Objectives: As therapeutic modalities for rheumatoid arthritis (RA) advance, immediate and quantitative determination of RA disease status is becoming increasingly important. The purpose of this study was to validate ...Objectives: As therapeutic modalities for rheumatoid arthritis (RA) advance, immediate and quantitative determination of RA disease status is becoming increasingly important. The purpose of this study was to validate the usefulness of a ring gauge as a simple semiquantitative method for assessing hand swelling in patients with RA. Methods: We enrolled patients diagnosed with RA either initiated or switched to a biological therapeutic agent. The circumference of the interphalangeal (IP) joint and the proximal interphalangeal (PIP) joint was measured using a ring gauge. Assessments of the joint echocardiography, incorporating both Gray Scale (GS) and Power Doppler (PD) imaging, were conducted. These evaluations were performed both before the initiation of biological agent treatment and 28 days after the initial dose. Results: Following the treatment intervention, a significant reduction was observed in the circumference of the joint from the thumb to the little finger (p Conclusions: Our study demonstrated the effectiveness of using a ring gauge as a simple assessment tool for RA, revealing that a change in the ring gauge number by 2 or more corresponded to either improvement or deterioration in synovial thickening detected via joint echocardiography.展开更多
Purpose: To evaluate personality characteris- tics’ impact upon outcome after silicone-based MP arthroplasty in RA patients. Methods: 40 RA patients who had undergone operations on their MP joints were investigated i...Purpose: To evaluate personality characteris- tics’ impact upon outcome after silicone-based MP arthroplasty in RA patients. Methods: 40 RA patients who had undergone operations on their MP joints were investigated in a one-year fol- low-up. Objective measurement to assess grip strength and active range of motion—Paper- pencil-tests to assess pain during activity and at rest performance, QoL, and personality. Results: Significant improvement was observed in func- tion and pain related scores except for the pain related VAS and in several QoL facets and do- mains. Patients who experienced improvement reported higher scores on the activities of daily living facet of the WHO QoL questionnaire. Those with lower pain showed more independ- ence. The variance of the QoL domain scores, other than social and physical domains, could substantially and meaningfully be explained by variance of objective measures combined with personality scores. Conclusions: Most RA pa- tients’ QoL can be improved by MP arthroplasty despite remaining substantial level of pain. NS and HA seem to play an important role in the adaptation process during the long term, chronic illness;whereas SD represents a tool of coping with the burden of pain and disability. Personal- ity characteristics are highly predictive for QoL suggesting their important mediating role be- tween experienced pain and disability and HR QoL.展开更多
目的:比较类风湿性关节炎(rheumatoid arthritis,RA)前足畸形重建术第5跖骨头切除成形与不切除的临床疗效。方法:回顾性分析2015年5月至2019年1月收治的50例(76足)女性RA致前足中重度畸形患者,依据第5跖趾关节退变情况,行RA前足重建第5...目的:比较类风湿性关节炎(rheumatoid arthritis,RA)前足畸形重建术第5跖骨头切除成形与不切除的临床疗效。方法:回顾性分析2015年5月至2019年1月收治的50例(76足)女性RA致前足中重度畸形患者,依据第5跖趾关节退变情况,行RA前足重建第5跖骨头保留或切除术,分为第5跖骨头保留组(保留组)和第5跖骨头切除组(切除组)。保留组24例,年龄47~81(60.37±8.60)岁;病程13~22(19.00±3.06)年;身体质量指数(body mass index,BMI)21~28(23.53±2.47)kg·m-2;中度拇外翻畸形6例(6足),重度拇外翻畸形18例(30足);采用第1跖趾关节融合联合第2-4跖趾关节成形及第5跖趾关节清理术治疗。切除组26例,年龄30~80(58.53±13.70)岁;病程8~25(17.94±3.92)年;BMI为20~28(24.60±2.03)kg·m-2;中度拇外翻畸形4例(4足),重度拇外翻畸形22例(36足);采用第1跖趾关节融合联合2-5跖趾关节跖骨头切除成形术治疗。观察并比较两组手术时间、术后并发症情况,比较术前和末次随访时拇外翻角(hallux valgus angle,HVA),第1-2跖骨间角(intermetatarsal angles between the first and the second metatarsals,IMAFS),第1-5跖骨间角(intermetatarsal angles between the first and the fifth metatarsals,IMAFF)变化情况,并采用日本足踝外科协会(Japanese Society for Surgery of Foot,JSSF)评价临床疗效。结果:50例均获得随访,切除组随访时间为14~46(25.30±8.83)个月;保留组随访时间为12~48(24.30±11.12)个月,两组随访时间比较,差异无统计学意义(P>0.05)。两组手术时间、术后并发症比较,差异无统计学意义(P>0.05)。切除组JSSF评分、HVA、IMAFS、IMAFF分别由术前的(45.09±3.35)分、(38.90±13.67)°、(12.88±1.72)°、(32.50±2.99)°改善至末次随访时的(81.60±3.27)分、(15.40±0.96)°、(9.06±2.27)°、(22.20±1.98)°(P<0.05);保留组分别由(47.09±3.96)分、(43.30±12.65)°、(13.99±3.13)°、(33.20±6.14)°改善至(83.10±3.66)分、(15.20±1.54)°、(8.99±1.02)°、(24.70±1.88)°。两组间术前及末次随访时JSSF评分、HVA、IMAFS、IMAFF比较,差异均无统计学意义(P>0.05)。末次随访时,两组JSSF评分中疼痛、畸形比较,差异有统计学意义(P<0.05)。结论:无论是类风湿前足重建术还是前足重建第5跖趾关节清理术,术后临床疗效及影像学结果均明显改善。对比类风湿前足重建术,类风湿前足重建第5跖趾关节清理术治疗类风湿前足中重度畸形,疼痛改善明显,但畸形改善较差。对于类风湿引起的前足中重度畸形,第5跖趾头关节面轻中度退变畸形的患者可考虑使用。展开更多
基金supported by grant#SZ-SZSTI2010 by the Shenzhen Science and Technology Innovation Committee(SZSTI),Guang Dong Basic and Applied Basic Research Foundation(2022B1515130010)Hong Kong Research Grant Council(RGC)funding projects(GRF#16308818,GRF#16309920,and GRF#16309421)Hong Kong Innovation and Technology Commission(HKITC)funding project(MHP/003/19).
文摘Rheumatoid Arthritis(RA)is an autoimmune disorder that hinders the normal functioning of bones and joints and reduces the quality of human life.Every year,millions of people are diagnosed with RA worldwide,particularly among elderly individuals and women.Therefore,there is a global need to develop new biomaterials,medicines and therapeutic methods for treating RA.This will improve the Healthcare Access and Quality Index and also relieve administrative and financial burdens on healthcare service providers at a global scale.Hydrogels are soft and cross-linked polymeric materials that can store a chunk of fluids,drugs and biomolecules for hydration and therapeutic applications.Hydrogels are biocompatible and exhibit excellent mechanical properties,such as providing elastic cushions to articulating joints by mimicking the natural synovial fluid.Hence,hydrogels create a natural biological environment within the synovial cavity to reduce autoimmune reactions and friction.Hydrogels also lubricate the articulating joint surfaces to prevent degradation of synovial surfaces of bones and cartilage,thus exhibiting high potential for treating RA.This work reviews the progress in injectable and implantable hydrogels,synthesis methods,types of drugs,advantages and challenges.Additionally,it discusses the role of hydrogels in targeted drug delivery,mechanistic behaviour and tribological performance for RA treatment.
文摘In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.
文摘Objective: The aim of this study was to evaluate the efficacy of digital panoramic radiographs using the JLA view pro-gram in cases of rheumatoid arthritis and compare them to CT scans of the patients. Methods: 40 patients with known condition of RA and clinical symptoms in the TMJ were selected for the study. Radiological evaluation included a panoramic radiograph of the TMJs that was taken and a computer tomography of the joints. In the panoramic radio-graphs taken, isolation of the TMJs was done using the JLA view program, while in the CT scans of the patients, all scans were taken with closed mouth, with a distance of 0.5 mm per slice. The parameters examined were: 1) Bony changes of the condyle;2) The position of the condyle in the mandibular fossa;3) The joint space;4) Bony changes of mandibular fossa. Results: There were no statistically significant differences found between the two observers or be-tween the two joints of the same patient [right and left] on the panoramic radiographs. For the case of CT scans there were significant differences between the joint space of right and left joints, while in the ANOVA performed differences were found for the evaluation of the bony changes of the condyle. Conclusion: There were no significant differences between the two radiographic methods selected and therefore when a proper simple radiograph is taken and well evalu-ated, the conclusions drawn from it are well based and there is no need for further
基金Supported by National Natural Science Foundation of China(82205105).
文摘Joint deformity and dysfunction are common and serious complications in the late stage of rheumatoid arthritis,which seriously affect the quality of life of patients.Traditional Chinese medicine(TCM)believes that joint deformity and dysfunction in some patients with rheumatoid arthritis are closely related to the apraxia of meridians and tendons due to enduring illness.Based on the theory of meridians and tendons circulation,using the local and nearby therapeutic effect of acupoints as the treatment method in clinical practice,we conducted penetration needling of Houxi,Baxie,Wailaogong as well as Ashi points of interphalangeal joints of both hands through bilateral Sanjian,and used the uniform reinforcing-reducing method to soothe tendons and meridians,thus effectively improving the dysfunction of deformed joints.
文摘Background: It has been accepted amongst rheumatologists that rheumatoid arthritis (RA) does not involve the facet joints (FJs) of the spine;nevertheless, the issue is still under debate. Objective: To compare the prevalence of FJs’ changes between patients with RA and age- and sex-matched peers. Methods: CT scans of 34 patients with RA suffering from low back pain (LBP) were compared with 70 age- and sex-matched controls (individuals without RA, suffering from LBP) in a case-control study. The degenerative changes in the FJs were evaluated (i.e., joint space narrowing, marginal osteophytes, articular process hypertrophy, subchondral sclerosis, inter-joint vacuum phenomenon, and subchondral cysts), in addition to the marginal erosions, the most characteristic feature of joint change in RA. Disease activity characteristics (CRP, ESR, DAS-28, SDAI, and CDAI), duration of RA, age, and sex were obtained from patients’ clinical charts. Results: The prevalence of FJs’ changes in patients with RA and age- and sex-matched controls were not significantly different at any spinal level or in a total L1-S1 score. Marginal erosions, a characteristic feature of joint changes in RA, were not found in any of our RA subjects. No difference was found in disease parameters and markers in individuals with RA with affected FJs and those without. The occurrence of FJs’ changes amongst subjects with RA demonstrated no correlation with disease duration and activity. Conclusions: FJs of the lumbar spine are not involved in the inflammatory process of RA, and their LBP is not due to inflammation in FJs of the spine.
文摘Background: Rheumatoid arthritis is a form of autoimmune disease characterized by synovitis that can ultimately cause joint deformities and impaired functioning. The cartilage destruction is one of the most important indicators for diagnosis and treatment of rheumatoid arthritis, and it is radiographically manifested as joint space narrowing. Issue: In the literature, the joint space narrowing progression between a baseline and its follow-up finger joint images can be quantified by using image registration algorithm. We found that the inconsistencies of joint angles may lead to characteristic mismatches and thus severely affect the accuracy of joint space narrowing quantifications. Methods: In this work, we introduce a rotation invariant phase only correlation in joint space narrowing quantification for the joint angle correction. Further, we propose a confidence index to quantify the quantification reliability of phase only correlation based on phase dispersion in phase difference spectrum. Conclusion: In our clinical experiments, the proposed quantification method can effectively overcome and manage the mismatch due to the inconsistency of joint angles. Additionally, the confidence index shows a high consistency with the joint space narrowing progression examinations manually done by a trained radiologist and one radiological technologist.
文摘Objectives: As therapeutic modalities for rheumatoid arthritis (RA) advance, immediate and quantitative determination of RA disease status is becoming increasingly important. The purpose of this study was to validate the usefulness of a ring gauge as a simple semiquantitative method for assessing hand swelling in patients with RA. Methods: We enrolled patients diagnosed with RA either initiated or switched to a biological therapeutic agent. The circumference of the interphalangeal (IP) joint and the proximal interphalangeal (PIP) joint was measured using a ring gauge. Assessments of the joint echocardiography, incorporating both Gray Scale (GS) and Power Doppler (PD) imaging, were conducted. These evaluations were performed both before the initiation of biological agent treatment and 28 days after the initial dose. Results: Following the treatment intervention, a significant reduction was observed in the circumference of the joint from the thumb to the little finger (p Conclusions: Our study demonstrated the effectiveness of using a ring gauge as a simple assessment tool for RA, revealing that a change in the ring gauge number by 2 or more corresponded to either improvement or deterioration in synovial thickening detected via joint echocardiography.
文摘Purpose: To evaluate personality characteris- tics’ impact upon outcome after silicone-based MP arthroplasty in RA patients. Methods: 40 RA patients who had undergone operations on their MP joints were investigated in a one-year fol- low-up. Objective measurement to assess grip strength and active range of motion—Paper- pencil-tests to assess pain during activity and at rest performance, QoL, and personality. Results: Significant improvement was observed in func- tion and pain related scores except for the pain related VAS and in several QoL facets and do- mains. Patients who experienced improvement reported higher scores on the activities of daily living facet of the WHO QoL questionnaire. Those with lower pain showed more independ- ence. The variance of the QoL domain scores, other than social and physical domains, could substantially and meaningfully be explained by variance of objective measures combined with personality scores. Conclusions: Most RA pa- tients’ QoL can be improved by MP arthroplasty despite remaining substantial level of pain. NS and HA seem to play an important role in the adaptation process during the long term, chronic illness;whereas SD represents a tool of coping with the burden of pain and disability. Personal- ity characteristics are highly predictive for QoL suggesting their important mediating role be- tween experienced pain and disability and HR QoL.
文摘目的:比较类风湿性关节炎(rheumatoid arthritis,RA)前足畸形重建术第5跖骨头切除成形与不切除的临床疗效。方法:回顾性分析2015年5月至2019年1月收治的50例(76足)女性RA致前足中重度畸形患者,依据第5跖趾关节退变情况,行RA前足重建第5跖骨头保留或切除术,分为第5跖骨头保留组(保留组)和第5跖骨头切除组(切除组)。保留组24例,年龄47~81(60.37±8.60)岁;病程13~22(19.00±3.06)年;身体质量指数(body mass index,BMI)21~28(23.53±2.47)kg·m-2;中度拇外翻畸形6例(6足),重度拇外翻畸形18例(30足);采用第1跖趾关节融合联合第2-4跖趾关节成形及第5跖趾关节清理术治疗。切除组26例,年龄30~80(58.53±13.70)岁;病程8~25(17.94±3.92)年;BMI为20~28(24.60±2.03)kg·m-2;中度拇外翻畸形4例(4足),重度拇外翻畸形22例(36足);采用第1跖趾关节融合联合2-5跖趾关节跖骨头切除成形术治疗。观察并比较两组手术时间、术后并发症情况,比较术前和末次随访时拇外翻角(hallux valgus angle,HVA),第1-2跖骨间角(intermetatarsal angles between the first and the second metatarsals,IMAFS),第1-5跖骨间角(intermetatarsal angles between the first and the fifth metatarsals,IMAFF)变化情况,并采用日本足踝外科协会(Japanese Society for Surgery of Foot,JSSF)评价临床疗效。结果:50例均获得随访,切除组随访时间为14~46(25.30±8.83)个月;保留组随访时间为12~48(24.30±11.12)个月,两组随访时间比较,差异无统计学意义(P>0.05)。两组手术时间、术后并发症比较,差异无统计学意义(P>0.05)。切除组JSSF评分、HVA、IMAFS、IMAFF分别由术前的(45.09±3.35)分、(38.90±13.67)°、(12.88±1.72)°、(32.50±2.99)°改善至末次随访时的(81.60±3.27)分、(15.40±0.96)°、(9.06±2.27)°、(22.20±1.98)°(P<0.05);保留组分别由(47.09±3.96)分、(43.30±12.65)°、(13.99±3.13)°、(33.20±6.14)°改善至(83.10±3.66)分、(15.20±1.54)°、(8.99±1.02)°、(24.70±1.88)°。两组间术前及末次随访时JSSF评分、HVA、IMAFS、IMAFF比较,差异均无统计学意义(P>0.05)。末次随访时,两组JSSF评分中疼痛、畸形比较,差异有统计学意义(P<0.05)。结论:无论是类风湿前足重建术还是前足重建第5跖趾关节清理术,术后临床疗效及影像学结果均明显改善。对比类风湿前足重建术,类风湿前足重建第5跖趾关节清理术治疗类风湿前足中重度畸形,疼痛改善明显,但畸形改善较差。对于类风湿引起的前足中重度畸形,第5跖趾头关节面轻中度退变畸形的患者可考虑使用。
