ABSTRACT
Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.
ABSTRACT
Objective To investigate the plasma protein concentration of S100B protein,hyperphosphorylated tau protein (P-tau) and β-amyloid (Aβ1-42) of rheumatoid arthritis (RA) patients with mild cognitive impairment (MCI) and to provide a reference for clinical diagnosis and prevention of cognitive dysfunction of RA patients.Methods The subjects were consisted of three groups:RA patients with MCI,RA patients with normal cognitive function (NC) and healthy controls.The Montreal Cognitive Assessment (MoCA)was used to test patients' cognitive function,generalized anxiety disorder scale-7 (GAD-7) scale and 9-item patient health questionnaire-9 (PHQ-9) were used to exclude anxiety and depression of RA patients.The concentration of S100B protein,P-tau protein and Aβ1-42 protein in plasma was detected by enzyme-linked immunosorbent assay (ELISA),and the correlation among the concentration of S100B protein,P-tau protein and MoCA scores was analyzed by Pearson's chi-squared test.Results ① Cognitive scores showed that some RA patients had MCI.② The plasma levels of S100B (F=11.81,P＜0.05),P-tau (F=3.3,P＜0.05) protein in RA patients with MCI were higher than that in NC RA patients and the control group (P＜0.05).③ The clinical index analysis showed that the concentration of C reactive protein (CRP) in RA patients with MCI was higher than that in NC RA patients and healthy control,the difference was statistically significant (t=6.44,P＜0.05).④The levels of plasma P-tau (r=-0.539,P＜0.05),S100B (r=-0.346,P＜0.05),CRP (r=-0.358,P＜0.05) protein were negatively correlated with cognitive scores (P＜0.05).Conclusion CRP,S100B protein and P-tau protein are associated with the pathogenesis of RA patients with MCI.The consequences of plasma concentration test can be com-bined with cognitive assessment questionnaire to provide reference for clinical diagnosis of RA patients with MCI.
ABSTRACT
The formation of physique was influenced by many factors and was closely related to the disease, especially by the social and cultural factors. According to the characteristics of physique, physique conditioning was conducive to rehabilitation of the disease. It was also the internal evidence for individualized treatment of rehabilitation. Traditional Chinese medicine (TCM) rehabilitation advocated functional rehabilitation as the main treatment purpose. Attentions were paid to promoteqi circulation. The psychological characteristics of the rehabilitation subject were especially emphasized on, in order to improve the therapeutic effect of rehabilitation. There were many classifications of physical evaluations, which were widely used in a variety of clinical diseases rehabilitation. The pathological physique correction and adjustment cannot be ignored in rehabilitation. Therefore, the application of physical evaluation in the guidance of rehabilitation therapy can enrich the content of TCM rehabilitation evaluation. It further improved TCM physical evaluation system to meet the needs for clinical practice and TCM modernization.