ABSTRACT
OBJECTIVES: To evaluate the outcomes of patients with rheumatoid arthritis (RA) of the knee who underwent five portal arthroscopic synovectomy, with or without post-operative negative pressure drainage (NPD). MATERIAL AND METHODS: A prospective clinical trial was performed. Patients with class I, II, and III RA of the knee were enrolled. They underwent five portal arthroscopic synovectomy. Post-operatively, they received either NPD (group A) or non-NPD (group B). Health assessment questionnaire (HAQ), disease activity score 28 (DAS 28), and Lysholm knee joint score were evaluated before the operations, and at six weeks, three months, and one year after the operations. RESULTS: A total of 36 patients were enrolled into the study, with 63.9% (23) female patients and mean age of 47.2 years old. All of the patients had clinical symptoms (joint swelling, pain, and dysfunction) for at least six months with poor responses to the traditional pharmaceutical therapy. There were 12, 16, and eight patients in class I, II, and III RA groups, respectively (six IA, six IB, eight IIA, eight IIB, four IIIA, and four IIIB). One year after the operation, patients had statistically significant improvements on HAQ, DAS 28, and Lysholm knee joint scores. More improvements were observed in patients with class I diseases. There were no statistically significant differences between group A and B. CONCLUSION: Five portal arthroscopic synovectomy could increase the quality of life, decrease disease activities, and improve joint functions in patients with RA. More benefits were observed in patients with early disease developments. Patients in the NPD group did not show more improvements compared to the patients in the non-NPD group.
ABSTRACT
PURPOSE: A meta-analysis was preformed to determine which HLA-DRB1 alleles are associated with increased risk of rheumatoid arthritis (RA) in Asian patients. METHODS: Medline, PubMed, Central, EMBASE, Cochrane, and Google Scholar databases were searched until November 3, 2015 using the following keywords: rheumatoid arthritis; RA, HLA-DRB1; severity; treatment; and, prognosis. Randomized-controlled-trials, prospective, retrospective, cohort and case-controlled studies that examined the HLA-DRB1 allelic association with RA in Asians were included. The frequencies of allelic types and the shared epitope (SE) were compared between patients with or without RA. RESULTS: A total of 331 articles were identified after duplicates removed, and 40 studies, with 5470 RA patients and 5837 control patients, were included in the analysis. Pooled odds ratios (ORs) revealed the frequencies of HLA-DRB1*04 and *10 were higher in the RA group, and the frequency of *14 was lower in the RA group as compared to controls (*04: OR = 3.35, 95% CI: 2.28-3.99, p < .001; *10: OR = 2.08, 95% CI: 1.55-2.78, p < .001; *14: OR = 0.70, 95% CI: 0.54-0.90, p = .006). No associations were noted for *01 and *09. Pooled ORs revealed associations of *0101 (OR = 1.58), *0401 (OR = 2.17), *0404 (OR = 1.91), *0405 (OR = 3.73), *0410 (OR = 2.24), *1001 (OR = 1.78) and SE positive (OR = 2.38) with RA. HLA-DRB1 *14 subtypes did not show associations with RA. CONCLUSIONS: HLA-DRB1 allelic variations are associated with RA in Asian patients.
