The Clinical Follow-up Analysis Of Knee Arthroscopic Synovectomy For Refractory Knee Arthritis

ObjectiveTo evaluate the clinical efficacy of knee arthroscopic synovectomy for the treatment of inflammatory arthritis in patients with knee involvement. To evaluate the diagnostic value of ultrasound in the knee joint synovial lesions of inflammatory arthritis, by comparing the consistency of ultrasound and arthroscopy in synovial lesions of the knee joint of inflammatory arthritis.MethodsA total of 23 knee j oints in 18 patients ( RA= 13 SpA=5) with refractory inflammatory arthritis were treated with knee arthroscopic synovectomy. Evaluated their synovial hyperplasia grade in the surgery. The clinical evaluation index,inflammation markers and ultrasound synovial hyperplasia grade were compared between the patients before surgery,3 months and 6 months after surgery to evaluate the clinical efficacy of knee arthroscopic synovectomy for the treatment of knee arthritis. Evaluated the patients' synovial hyperplasia grade in the surgery. Ultrasound synovial hyperplasia grade and arthroscopic synovial hyperplasia grading results were compared to evaluate the diagnostic consistency of ultrasound and arthroscopy in the treatment of knee synovial lesions.ResultsHospital for Special Surgery (HSS) knee score, knee discomfort score, knee patellar capsule synovial thickness, patient global assessment, Health assessment questionnaire(HAQ) score and disease activity improved significantly at 3, 6 month post-operation in combined pre-operation. Ultrasound synovial hyperplasia and blood flow grade also decreased significantly. Gray scale ultrasound synovial hyperplasia and arthroscopic synovial hyperplasia grading, in the suprapatellar pouch, medial and lateral parapatellar recesses Kappa values were 0.412, 0.410, 0.563, all of them with a moderate to high degree of consistency.ConclusionKnee arthroscopic synovectomy for the treatment of inflammatory arthritis with knee joint involvement has a good effect, which can quickly improve joint symptoms,reduce disease activity and improve patient quality of life. Gray scale ultrasound evaluation of knee synovial hyperplasia grading compared with arthroscopy has a good consistency. Ultrasound can be used as a supplement mean of examination to diagnose knee synovial lesions in clinical application.ObjectiveTo investigate the gender-attributable differences in clinical characteristics and life quality of ankylosing spondylitis (AS) patients.MethodsA total of 522 AS patients (80 females and 442 males) were collected from the Department of Rheumatology, Chinese PLA General Hospital from August 2013 to September 2015. A comparison was conducted in terms of age at onset, disease course,family history, HLA-B27, clinical manifestations, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and AS Disease Activity Score (ASDAS),physical function by the Bath Ankylosing Spondylitis Functional Index(BASFI), Spinal mobility by the Bath Ankylosing Spondylitis Metrology Index(BASMI) and quality of life(QoL) by the Short Form-36 between male and female patients.ResultsCompared with male patients, female patients were older at disease onset(24.3±9.2 vs 20.5±7.5,P<0.001),and had higher rates of peripheral articular involvement(55.6% vs 40.5%, P<0.05), lower BASMI scores, and a lower mental health score(54.2±15.4 vs 58.2±16.9,P<0.05). But no significant gender-attributable difference was observed in other clinical parameters like low back pain, patients' global assessment scores, enthesitis,BASDAI, BASFI and ASDAS. In age <40 years old group, female patients had lower ASDAS scores (2.5±1.3 vs 2.7±1.2,P<0.05) and lower mental health scores (54.8±14.8 vs 58.5±17.0, P<0.05) than male. In the age?40 years old group, female had lower physical functioning and bodily pain scores in SF-36 than man. Female patients with positive HLA-B27 had lower mental health and bodily pain scores, and Female patients in highly active disease stage had lower bodily pain score than male patients. There was a significant improvement in ASDAS scores in female patients compared with male (1.3±1.7 vs 0.9±1.0,P=0.044).ConclusionAS more likely occurs in older age, had higher rates of peripheral articular involvement,and results in poor QoL in female patients than in male, especially in mental health domain.Moreover, significant impairment of spinal mobility are found in male AS patients. No gender-attributable differences in disease activity or physical function are found between male and female patient, which indicating that female disease should be paid the same attention on as male patients in the clinical diagnosis and treatment.