Abstract：
OBJECTIVE: To investigate whether there is a difference in the efficacy of intra-articular injection of tumor necrosis factor (TNF) inhibitor and triamcinolone acetonide (HA) in rheumatoid arthritis (RA) patients with recurrent synovitis after the first intra-articular injection of HA.
METHODS: RA patients who relapsed 12 weeks after the first HA treatment were enrolled in this study. After joint cavity extraction, recombinant human TNF receptor-antibody fusion protein (TNFR:FC) (25 mg or 12.5 mg) or HA (1 ml or 0.5 ml) was injected then. The changes in the visual analog scale (VAS), joint swelling index, and joint tenderness index before and 12 weeks after reinjection were compared and analyzed. The changes in synovial thickness, synovial blood flow, and fluid dark zone depth before and after reinjection were observed by ultrasound.
RESULTS: Forty-two RA patients were enrolled, including 11 males and 31 females, with an average age of 46.79 ± 12.61 years and an average disease duration of 7.76 ± 5.44 years. After 12 weeks of intra-articular injection of HA or TNFR:FC, the VAS scores were significantly lower than those before treatment (P < 0.01). After 12 weeks of injection, the scores of the joint swelling index and tenderness index in both groups were significantly decreased compared with those before treatment. There was no significant difference in synovial thickness under ultrasound in the HA group before and after injection, while the synovial thickness in the TNFR:FC group was significantly improved after 12 weeks (P < 0.01). After 12 weeks of injection, the grade of synovial blood flow signal in both groups decreased significantly compared with that before treatment, especially in the TNFR:FC group. After 12 weeks of injection, the depth of the liquid dark area under ultrasound decreased significantly in the HA group and TNFR:FC group compared with that before treatment (P < 0.01).
CONCLUSIONS: Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. Compared with HA treatment, it can reduce synovial thickness. Key Points • Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids can not only relieve joint pain but also significantly inhibit joint swelling. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids cannot only improve synovial inflammation but also inhibit synovial proliferation. • For the treatment of refractory RA synovitis, biological agents combined with glucocorticoid injection are an effective and safe option.
METHODS: RA patients who relapsed 12 weeks after the first HA treatment were enrolled in this study. After joint cavity extraction, recombinant human TNF receptor-antibody fusion protein (TNFR:FC) (25 mg or 12.5 mg) or HA (1 ml or 0.5 ml) was injected then. The changes in the visual analog scale (VAS), joint swelling index, and joint tenderness index before and 12 weeks after reinjection were compared and analyzed. The changes in synovial thickness, synovial blood flow, and fluid dark zone depth before and after reinjection were observed by ultrasound.
RESULTS: Forty-two RA patients were enrolled, including 11 males and 31 females, with an average age of 46.79 ± 12.61 years and an average disease duration of 7.76 ± 5.44 years. After 12 weeks of intra-articular injection of HA or TNFR:FC, the VAS scores were significantly lower than those before treatment (P < 0.01). After 12 weeks of injection, the scores of the joint swelling index and tenderness index in both groups were significantly decreased compared with those before treatment. There was no significant difference in synovial thickness under ultrasound in the HA group before and after injection, while the synovial thickness in the TNFR:FC group was significantly improved after 12 weeks (P < 0.01). After 12 weeks of injection, the grade of synovial blood flow signal in both groups decreased significantly compared with that before treatment, especially in the TNFR:FC group. After 12 weeks of injection, the depth of the liquid dark area under ultrasound decreased significantly in the HA group and TNFR:FC group compared with that before treatment (P < 0.01).
CONCLUSIONS: Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. Compared with HA treatment, it can reduce synovial thickness. Key Points • Intra-articular injection of a TNF inhibitor is an effective method for the treatment of recurrent synovitis after conventional hormone therapy. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids can not only relieve joint pain but also significantly inhibit joint swelling. • Compared with HA treatment, intra-articular injection of biological agents combined with glucocorticoids cannot only improve synovial inflammation but also inhibit synovial proliferation. • For the treatment of refractory RA synovitis, biological agents combined with glucocorticoid injection are an effective and safe option.
摘要：
目的：探讨肿瘤坏死因子(TNF)抑制剂与曲安奈德(HA)关节腔内注射治疗类风湿关节炎(RA)患者关节腔内注射HA后复发滑膜炎的疗效是否存在差异。
方法：本研究纳入首次HA治疗后12周复发的RA患者。关节腔拔除后，然后注射重组人TNF受体-抗体融合蛋白(TNFR:FC)(25mg或12.5mg)或HA(1ml或0.5ml)。视觉模拟量表(VAS)的变化，关节肿胀指数,并对回注前和回注后12周的关节压痛指数进行比较分析。滑膜厚度的变化，滑膜血流,超声观察回注前后流体暗区深度。
结果：纳入42例RA患者，包括11名男性和31名女性，平均年龄46.79±12.61岁，平均病程7.76±5.44岁。关节内注射HA或TNFR：FC12周后，VAS评分较治疗前明显降低(P<0.01)。注射12周后，两组患者关节肿胀指数和压痛指数评分均较治疗前显著下降。HA组注射前后超声下滑膜厚度无明显差异,12周后TNFR:FC组滑膜厚度明显改善(P<0.01)。注射12周后，两组滑膜血流信号分级均较治疗前明显下降,特别是在TNFR：FC组中。注射12周后，与治疗前相比，HA组和TNFR：FC组超声下液体暗区深度明显下降（P<0.01）。
结论：关节腔内注射TNF抑制剂是治疗常规激素治疗后复发性滑膜炎的有效方法。与HA治疗相比，它可以减少滑膜厚度。要点•关节内注射TNF抑制剂是治疗常规激素治疗后复发性滑膜炎的有效方法。•与HA治疗相比，关节腔内注射生物制剂联合糖皮质激素不仅可以缓解关节疼痛，而且可以明显抑制关节肿胀。•与HA治疗相比，关节内注射生物制剂联合糖皮质激素不仅能改善滑膜炎症，还能抑制滑膜增生。•对于难治性RA滑膜炎的治疗，生物制剂联合糖皮质激素注射是一种安全有效的选择。
方法：本研究纳入首次HA治疗后12周复发的RA患者。关节腔拔除后，然后注射重组人TNF受体-抗体融合蛋白(TNFR:FC)(25mg或12.5mg)或HA(1ml或0.5ml)。视觉模拟量表(VAS)的变化，关节肿胀指数,并对回注前和回注后12周的关节压痛指数进行比较分析。滑膜厚度的变化，滑膜血流,超声观察回注前后流体暗区深度。
结果：纳入42例RA患者，包括11名男性和31名女性，平均年龄46.79±12.61岁，平均病程7.76±5.44岁。关节内注射HA或TNFR：FC12周后，VAS评分较治疗前明显降低(P<0.01)。注射12周后，两组患者关节肿胀指数和压痛指数评分均较治疗前显著下降。HA组注射前后超声下滑膜厚度无明显差异,12周后TNFR:FC组滑膜厚度明显改善(P<0.01)。注射12周后，两组滑膜血流信号分级均较治疗前明显下降,特别是在TNFR：FC组中。注射12周后，与治疗前相比，HA组和TNFR：FC组超声下液体暗区深度明显下降（P<0.01）。
结论：关节腔内注射TNF抑制剂是治疗常规激素治疗后复发性滑膜炎的有效方法。与HA治疗相比，它可以减少滑膜厚度。要点•关节内注射TNF抑制剂是治疗常规激素治疗后复发性滑膜炎的有效方法。•与HA治疗相比，关节腔内注射生物制剂联合糖皮质激素不仅可以缓解关节疼痛，而且可以明显抑制关节肿胀。•与HA治疗相比，关节内注射生物制剂联合糖皮质激素不仅能改善滑膜炎症，还能抑制滑膜增生。•对于难治性RA滑膜炎的治疗，生物制剂联合糖皮质激素注射是一种安全有效的选择。
