| ObjectiveRheumatoid arthritis(RA)is an autoimmune disease which symmetrically attacks arthrosynovitis.Its sufferers are faced with high rates of joint deformity and disability,with its morbidity and mortality increasing by years.A clear and sound understanding of RA pathogenesis is still in absence,yet scholars home and abroad generally believe joint damage is the major cause for RA sufferers' disability and that synovial hyperplasia and pannus lesions play a rather significant role therein.Defining characteristics of diagnosis for RA include sufferers' clinical manifestations,physical signs,imageological examination and autoantibody like rheumatoid factors(RF)and anti-cyclic citrullinated peptide antibody(CCP).Currently the ACR/EULAR2009 RA Diagnostic New Criteria is very helpful in early diagnosis for RA,but clinically 5%-8%sufferers are misdiagnosed or fail to be treated in time;an especially severe situation is that Rheumatoid arthritis patients with the major clinical manifestation of single/oligonucleotides joint swelling lack the objective evidence for diagnosis.Current treatment for RA relies heavily on slow acting anti-rheumatic drugs(SAARD)and non-steroidal anti-inflammatory drugs(NSAID).The treatment is chiefly intended to relief symptoms of joint swelling and pain,delay or block bone and joint damage,but cannot reverse joint damage that has already occurred.Therefore,early diagnosis and early interventional treatment for RA can help reduce the probability of bone damage and joint disability and is a crucial problem concerning the control and prognosis of the disease.By virtue of clinical and experimental study,this paper aims to visually observe the knee joint tissues and structures of RA patents under minimally invasive needle knife mirror,including synovial hyperplasia,pannus formation,cartilage and meniscus injury,and probe into the relevance between these pathological changes and rheumatoid factors and CCP antibody,so as to draw a systematic conclusion of pathological changes including visible synovial hyperplasia,pannus formation,cartilage and meniscus injury under minimally invasive needle knife mirror.Hopefully,this conclusion will become a powerful tool for clinical diagnosis of atypical RA,enabling early treatment for RA sufferers.Meanwhile,the paper probes into the correlation of visible tissue and structure changes inside RA patients' knee articular cavity under minimally invasive needle knife mirror and the levels of serum RF and CCP antibody,to discuss the roles of these two antibodies in the development of RA pathological changes and their feasibility and reliability in pathological change assessment for RA tissues and structures.Also,by virtue of observing channel tendon minimally invasive loosening therapy's clinical therapeutic effects on RA and its safety,the paper concludes a systematic evaluation on the clinical value of TCM minimally invasive therapeutic devices like minimally invasive needle knife mirror and channel tendon knife.MethodsIn the experimental study,116 patients are selected according to R A diagnostic criteria.80 of them meet the American College of Rheum atology(ACR)1987 revised criteria for RA while the remaining 36 li ve up to the ACR/EULAR 2009 new criteria but fail the ACR 1987 criteri a.All selected patents have their serum RA and CCP antibody levels measu red.Under infiltration anaesthesia by 1%lidocaine,minimally invasiv e needle knife mirror inspection and treatment are conducted.During th is process,the patents' visible tissue and structure performances under mirror were observed and recorded,including synovial membrane,degree of hyperplasia,position and extent of pannus formation,degree of cartila ge destruction and meniscus injury.During clinical study,80 Rheumatoid arthritis patients are selected in accordance with the ACR/EULAR 2009 new diagnostic criteria,subject inclusion and exclusion criteria,and divi ded into two groups according to random number table,namely the trea tment group given channel tendon minimally invasive loosening therapy and the control group given oral medication,40 patents in each group.The control group receives conventional treatment and orally takes 10mg of m ethotrexate per week and 0.2g of celecoxib capsules per day,while the tr eatment group is given channel tendon minimally invasive loosening ther apy on the basis of the control group's treatment.After one course of tr eatment(3 weeks),arthritis symptoms,physical signs,TCM symptoms,lab therapeutic effect indicators(blood sedimentation,C-reactive protein,RA and CCP antibody)and safety indexes(blood routine,liver and kidne y functions)of both groups before and after the treatments were observe d.Comparison was made in each group respectively before and after trea tment,while the results were also compared between groups.ResultsWith detailed observation and description of visible synovial membrane of RA' s knee joint,degree of hyperplasia,lesion position of pannus formation,degree of cartilage destructionand meniscus erosion under minimally invasive needle knife mirror,this paper comes to an observation,quantification and classification standard for knee joint pannus,which provides a new method for atypical RA diagnosis.The results also prove RA' s knee joint synovial diseases and cartilage injury have certain correlation with the RF and CCP antibody levels in serum.Clinically,indicators of the VAS pain scores,DAS28,ACR20,ACR50 and raditional Chinese medicine curative effect evaluation for both groups have all improved after treatment.The VAS pain scores,ACR improvement rate and traditional Chinese medicine curative effect evaluationin the treatment group are superior to those in the control group,representing statistically significantdifferences(P<0.05).Both groups remarkably improve in joint pain counts,swollen joint counts and morning stiffness duration,degree of joint flexion and extension,as well as local temperature after treatment,with statistically significant differences(P<0.05).After treatment,both groups see reduction in blood sedimentation,C-reactive protein andRF.Reduction of C-reactive protein in the treatment group apparently precedes the control group with statistically significant differences(P<0.05).Blood sedimentation and RFof the treatment group are statistically insignificant(P>0.05)when compared to those of the control group.Reexaminations after three weeks for both groups indicate nothing apparently abnormal in blood routine and liver and kidney functions(P>0.05).Conclusion1.This study demonstrates that synovial hyperplasia,pannus formation and cartilage injury inside joints can be visually and directly observed throughminimally invasive needle knife mirror inspection,and comes up with a systematical observation,quantification andclassification standard for knee joint pannus,which provides a new method for atypical RA diagnosis.Helpful for RA' s diagnosis,this method enables accurate judgment on the scope and degree of damage inside the pathological joint which lays basis for follow-up treatment.2.The results unveil a certain correlation between changes in RA patents' articular cavity synovial hyperplasia and pannus injury,and the levels of serum RF and CCP antibody.Levels of RF and CCP antibodyindicate a positive correlation with the severity of RA's synovial hyperplasia and cartilage changes,but have no direct relation with the severity of meniscus injury.3.Channel tendon minimally invasive loosening therapy can improve RA patents' clinical symptoms and physical signs as well as lab inflammatory indicators.With remarkable clinical efficacy and safety,the therapy has distinct effects on anti-inflammation,detumescence andanalgesia.With the merit to shorten the treatment course for RA and remedy the defect of internal medicine to improve the overall therapeutic effect,the therapy turns out to be an effective method for external application in traditional Chinese medicine to treat rheumatoid arthritis. |
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