Rheumatoid Arthritis: Lv H

Zheng RL, Lv H, Zhang W, Yu MX, Yuan Y. · Department of Neurology, Peking University First Hospital, Beijing 100034, China. · Beijing Da Xue Xue Bao. · Pubmed #16778982 No free full text.

Abstract: To report the clinical, radiological and neuropathological findings of a patient with rheumatoid meningitis. The patient was a 71-year-old Chinese man with a two-year history of rheumatoid arthritis and no other significant medical history, who presented to our hospital recurrent weakness of his left extremities, dysarthria and a continuous bilateral hand tremor. Cerebrospinal fluid (CSF) and serum examinations were normal apart from a mildly raised serum perinuclear antineutrophil cytoplasmic autoantibody (p-ANCA). Brain magnetic resonance imaging (MRI) showed leptomeningeal enhancement in both frontal and parietal lobes, in addition to several old white matter infarcts. Meningeal biopsy showed numerous infiltrating macrophages and lymphocytes within the leptomeninges. The patient responded clinically and radiologically to corticosteroid and cyclophosphamide therapy. The patient subsequently developed herpes zoster over his left chest as a complication of his immunosuppressive treatment. His cyclophosphamide was ceased and intravenous immunoglobulin (IVIG) therapy was commenced, with good clinical response to both the herpes zoster and meningitis. According to the result of the biopsy, aseptic meningitis was considered the MRI results and the patient's clinical history were given, and a diagnosis of rheumatoid meningitis was made. The patient was p-ANCA positive. Although there was no evidence for cerebral vasculitis on biopsy, it remains a possibility that the patient's recurrent minor cerebral infarcts visible on MRI were vasculitic in nature.

Guan Z, Lv H, Shi M. · Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, 100044, PR China. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #16827380 No free full text.

Abstract: OBJECTIVE: To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. METHODS: Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpion posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirty-three patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8 degrees (range, 5-140 degrees). According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexion-contracture less than 20 degrees (range, 0-15 degrees), and group B consisted of the patients with flexion-contracture not less than 20 degrees (range, 20-60 degrees). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7 +/- 8.0 degrees, 104.6 +/- 20.0 degrees, 29.1 +/- 18.0, and 32.6 +/- 20.7, respectively. But the corresponding data were much worse in group B than in group A, which were 28.2 +/- 7.8 degrees, 60.8 +/- 26.6 degrees, 12.1 +/- 13.2, and 26.8 +/- 18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee. RESULTS: The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4 +/- 2.1 degrees, 108.6 +/- 19.0 degrees, 82.1 +/- 13.8, and 72.3 +/- 29.1, respectively; and the corresponding data in group B were 1.3 +/- 3.2 degrees, 98.6 +/- 16.40, 75.9 +/- 8.2, and 81.4 +/- 26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. CONCLUSION: The curative effect is mainly determined by the surgeon's good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexion-contracture deformity. The knee ROM after TKA, which has a "toward middle ROM" phenomenon, is influenced by many clinical factors. It is very important for the patient to perform a functional exercise of the knee as early as possible after operation.

Li H, Lv H, Kou B. · Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, PR China. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #16827378 No free full text.

Abstract: OBJECTIVE: To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prostheses implanted in the total knee arthroplasty (TKA). METHODS: Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prostheses from September 2003 to March 2004. Preoperative KSS knee scores were 16.08 +/- 11.58, function scores 13.75 +/- 19.79, and the range of motion (ROM) of the knee 75.00 +/- 26.46 degrees. Meanwhile, 50 knees of 30 patients (the Scorpio group) were followed up, who had undergone TKA with the Scorpio posterior stabilized prostheses. Preoperative KSS knee scores were 19.48 +/- 9.67, function scores 3.16 +/- 19.82, and the ROM of the knee 80.80 +/- 22.82 degrees. The anteroposterior and lateral X-ray films of each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. RESULTS: The average of the 130 days' follow-up revealed that the patients implanted with the TC-Dynamic prostheses had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83 +/- 4.04 with improved scores of 72.75 +/- 14.47 compared with those before operation; function scores were 79.17 +/- 5.15 with improved scores of 65.42 +/- 19.47; the ROM of the knee was 107.92 +/- 11.57 degrees with increased degrees of 32.92 +/- 32.22 degrees. Meanwhile, in the Scorpio group, the KSS knee scores were 85.68 +/- 7.36 with improved scores of 66.20 +/- 10.44 compared with those before operation; function scores were 71.40 +/- 12.70 with improved scores of 68.24 +/- 25.35; the ROM of the knee was 109.20 +/- 11.13 degrees with increased degrees of 28.40 +/- 26.41 degrees. There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups (P > 0.01). All the X-ray films of the knees implanted with both the Scorpio prostheses and the TC-Dynamic prostheses were analyzed. No mal-alignment or lucent line with the prostheses was seen in all these X-ray films. CONCLUSION: The short-term follow-up indicates that the patients implanted with the TC-Dynamic prostheses have an excellent result. The TC-Dynamic prostheses with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prostheses should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of the bone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the long-term high survival rate of the knee prostheses.