Department of Rheumatology and Rehabilitation, Sohag University Hospital, Sohag.
Department of Rheumatology and Rehabilitation, Minia University Hospital, Minia, Egypt.
Clin J Pain. 2021 Jun 1;37(6):413-420. doi: 10.1097/AJP.0000000000000935.
This study attempted to test the effectiveness of digital nerve block (DNB) in active rheumatoid arthritis (RA) joints with respect to local disease control.
The study included 83 RA patients aged 18 years or above and diagnosed, after American College of Rheumatology/European League Against Rheumatism criteria 2010, with bilateral proximal interphalangeal (PIP) arthritis. PIPs were examined by European League Against Rheumatism-outcome measures in rheumatoid arthritis clinical trials scoring system at 0, 2, and 8 weeks. Visual analog scales for each hand were also done at the same intervals. DNBs of the second and third PIPs were performed to the dominant hand in 50% of participants. The other hand was used as a control, and saline was injected in the same level at the control side.
At 2 weeks and 8 weeks intervals, the active side showed significantly less clinical and ultrasound scores when compared to the control side and the baseline values. The mean OMERACT score for the active hand dropped from 3.37±1.43 at 0 time to 2.31±1.66 after 2 weeks and 2.55±1.43 at 8 weeks (P<0.001). Also, visual analog scale decreased from 59 at 0 time to 41 at 2 weeks and 43 at 8 weeks (P<0.001). The amelioration was greater when the active side was the dominant one. The injected PIPs showed maximum improvement at 2 weeks. Improvement was more significant in the second PIP. Early patients achieved better outcomes.
DNB is a new promising therapy for RA. It can control pain and inflammation of the PIPs. It has relatively short-term effect, yet it could limit escalation of systemic treatment plans.
本研究旨在测试数字神经阻滞（DNB）在活跃性类风湿关节炎（RA）关节中对局部疾病控制的有效性。
该研究纳入了 83 名年龄在 18 岁及以上且符合美国风湿病学会/欧洲抗风湿病联盟 2010 年标准的双侧近端指间关节（PIP）关节炎的 RA 患者。使用欧洲抗风湿病联盟-类风湿关节炎临床试验结局测量评分系统在 0、2 和 8 周时对 PIP 进行检查。同时在相同的时间间隔内对手的视觉模拟量表进行检查。在 50%的参与者的优势手上进行第二和第三 PIP 的 DNB，而对侧手作为对照，在对照侧的同一水平注射生理盐水。
在 2 周和 8 周的时间间隔内，与对照侧和基线值相比，活动侧的临床和超声评分显著降低。优势手的 OMERACT 评分从 0 时间的 3.37±1.43 降至 2 周时的 2.31±1.66 和 8 周时的 2.55±1.43（P<0.001）。同样，视觉模拟量表从 0 时间的 59 降至 2 周时的 41 和 8 周时的 43（P<0.001）。当优势手是惯用手时，改善程度更大。注射的 PIP 在 2 周时得到最大改善。第二 PIP 的改善更为显著。早期患者的预后更好。
DNB 是 RA 的一种有前途的新疗法。它可以控制 PIP 的疼痛和炎症。它具有相对短期的效果，但可以限制全身性治疗方案的升级。
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