Centre For Rheumatology, Department of Medicine, University College of London Hospital, London, UK.
Lupus. 2009 Dec;18(14):1298-302. doi: 10.1177/0961203309345795. Epub 2009 Oct 22.
A small but important group of patients in our lupus cohort has needed total joint replacement (TJR). Arthritis was identified in 94% of our lupus patients. We have determined how many of our patients needed TJR, explored the risk factors for this procedure in patients with SLE and reviewed the outcome for these patients. Records of the cohort of patients with SLE who have attended our lupus clinic at University College of London Hospital/Middlesex from 1978 to 2008 were reviewed and patients who underwent TJR were identified. We recorded demographic data, other major systemic manifestations of SLE, autoantibody profile, previous use of steroids, other major systemic illnesses, smoking and alcohol habits. Nineteen patients with SLE from our cohort of 500 were found to have at least one TJR. Avascular necrosis (AVN) or concomitant rheumatoid arthritis (RA) was present in the majority of these patients. In contrast, age at disease onset, the presence of anti-cardiolipin antibodies, Raynaud's phenomenon and smoking habits were not found to be contributing factors for the need to replace joints. Four of our 19 patients (21.1%) had complications of the joint replacement: two of them had infections of the replaced joint, one had a large haematoma immediately after the surgery requiring surgical evacuation and the other had a deep vein thrombosis. None of the patients so far has required joint re-replacement. In conclusion, 4% of SLE patients in our cohort have one or more joints replaced, the majority because of AVN or RA.
在我们的狼疮队列中，有一小部分但很重要的患者需要进行全关节置换术（TJR）。我们的狼疮患者中有 94%出现了关节炎。我们确定了需要 TJR 的患者数量，探讨了 SLE 患者进行该手术的风险因素，并回顾了这些患者的治疗结果。我们回顾了 1978 年至 2008 年在伦敦大学学院医院/米德尔塞克斯大学风湿病诊所就诊的狼疮患者队列的记录，并确定了接受 TJR 的患者。我们记录了患者的人口统计学数据、其他主要系统性狼疮表现、自身抗体谱、既往使用类固醇情况、其他主要系统性疾病、吸烟和饮酒习惯。在我们 500 名狼疮患者队列中，发现有 19 名患者至少接受了一次 TJR。这些患者大多数存在股骨头坏死（AVN）或同时患有类风湿关节炎（RA）。相比之下，发病年龄、抗心磷脂抗体、雷诺现象和吸烟习惯并不是需要关节置换的因素。我们的 19 名患者中有 4 名（21.1%）出现了关节置换并发症：其中 2 名患者出现了置换关节感染，1 名患者术后立即出现了大量血肿，需要手术清除，另 1 名患者出现了深静脉血栓形成。迄今为止，没有患者需要再次进行关节置换。总之，我们队列中 4%的狼疮患者需要进行一个或多个关节置换，大多数是因为 AVN 或 RA。
