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Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.
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Objective:To construct a prediction model for difficult tracheal intubation in the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods:A total of 324 patients with OSAHS undergoing surgery with general anesthesia, admitted to our hospital from June 2019 to June 2021, were included in model group, and 175 patients with OSAHS undergoing surgery with general anesthesia, admitted from July 2021 to July 2022, were selected and served as validation group. The patients in model group were divided into occurrence group and non-occurrence group according to whether difficult tracheal intubation occurred. Logistic regression was used to construct the prediction model, and R4.2.1 software was used to draw the risk nomogram and calibration curve. The predictive accuracy of the model was evaluated by the area under the receiver operating characteristic curve.Results:Body mass index (BMI), sagittal minimum cross-sectional area, horizontal minimum cross-sectional area and mandibular distance were risk factors for difficult tracheal intubation in OSAHS patients ( P<0.05). A prediction model was developed using the above factors: Logit P=33.726+ 1.411×BMI score-0.014×sagittal airway minimum cross-sectional area-0.013×airway horizontal minimum cross-sectional area-0.312× mandibular distance. The area under the receiver operating characteristic curve was 0.846, Youden index 0.585, sensitivity 0.831, specificity 0.755, and the accuracy 0.889 (Hosmer-Lemeshow test χ2=9.24, P=0.322) in model group. The area under the external validation curve was 0.802, Youden index 0.545, sensitivity 0.636, specificity 0.908, and the accuracy 0.893 (Hosmer-Lemeshow test χ2=10.24, P=0.287) in validation group. Conclusions:The prediction model based on BMI, sagittal minimum cross-sectional area of airway, horizontal minimum cross-sectional area of airway and mandibular distance has a high value in predicting the risk of difficult tracheal intubation in patients with OSAHS.
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To analyze the clinical and psychological characteristics of fibromyalgia (FM), so as to further understand and improve the capability of identifying FM. The clinical data of 250 FM patients diagnosed in the outpatient clinic of the Department of Rheumatology, the First Medical Center, Chinese PLA General Hospital, from December 2019 to September 2021, were collected and analyzed. The patients aged 40 (31.0, 52.3) years, including 188 female patients (75.2%) and 62 male patients (24.8%). There was a statistically significant difference in age comparison between female [42.5 (33.0,54.0) years] and male patients [32.5 (27.8,43.5) years] ( P<0.001). The score of pain degree was 6 (4, 8), and [7 (5, 8)] of female patients was higher than [6 (4, 7)] of the male patients ( P=0.040). The widespread pain index (WPI) was 13 (10,15). The regions with high pain incidence were left shoulder girdle (87.2%, 218/250), right shoulder girdle (86.8%, 217/250), upper back (86.4%, 216/250), neck (79.6%, 199/250) and lower back (77.6%, 194/250) and etc. The incidence of chest pain in female patients (55.3%, 104/188) was lower than that in male patients (75.8%, 47/62) ( P=0.004). The symptom severity scale (SSS) score was 8 (7-10). 74.6% (185/248) suffered from anxiety and 77.5% (193/249) suffered from depression in 249 patients. Female patients were more common in FM patients than male patients, the median age of female patients was older than that of male patients, and the median score of pain severity of female patients was higher than male patients. Shoulders girdle, upper back, neck and lower back were the most frequently reported pain regions, and the incidence of chest pain in female patients was lower than that in male patients. The incidence of major non-painful symptoms was high and the proportion with anxiety or depression was high. The above clinical features are very helpful for early diagnosis of FM.
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Objective To compare the effect of intra-articular injection of recombinant human tumor necrosis factor-Fc (rhTNFR:Fc) in the treatment of knee arthritis in spondyloarthritis (SPA) with that in rheumatoid arthritis (RA).Methods The subjects included in this study were SpA and RA patients with knee arthritis without deformity,moderate or severe bone erosion and obvious joint space narrowing in radiography,who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study.All subjects received one dose of 25 mg rhTNFR:Fc injected to the target knee joints after synovial fluid being drawn away before injection.They were followed up for four weeks after injection.The primary end-point was the 4-week change in the moditied hospital for special surgery (HSS) knee score for the target knee.The secondary end-point were the 4-week change in patients assessment of the knee,and investigators assessment of knee,pain VAS of the knee joint when walking or standing,the range of knee inflexion,circumference of the knee cross section,synovium thickness detected by ultrasound in the part of the thickest synovium in the suprapatellar bursa.Paired t test,independed t test and Wilcoxon test were used for statistical analysis.Results Twenty-seven SpA patients and fifteen RA patients were included in the trial.The modified HSS knee score for the SpA group was 66±14 at baseline,86±11 (P＜0.05) at follow-up,and for the RA group,the score was 64±13 at baseline,80±9 (P＜0.05) at follow-up.24.2％ (16.5％-41.9％) improve-ment on the modified HSS knee score was achieved in the SpA group,while 22.2％ (15.3％-37.7％) improvement on the modified HSS knee score was achieved in the RA group (P＞0.05).31.8％ (9.3％-57.3％) improvement on the synovium thickness was achieved in the SpA group,while 1.5％ (-19.3％-25.5％) improvement on the synovium thickness was achieved in the RA group (P＜0.05).Adverse events were observed in six patients in SpA group and two patients in RA group.No serious adverse events had been observed.Conclusion Single intra-articular rhTNFR:Fc injection is an effective and safe therapeutic option for knee arthritis in both SpA and RA patients.This treatment may relieve knee synovitis in SpA patients more effectively than in RA patients.
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Objective To observe the clinical effects and security of spinal-epidural anesthesia in elderly patients with hip replacement.Methods 40 elderly patients classified Ⅱ ～ Ⅲ grade by ASA,treated by hip replacement and spinal-epidural anesthesia,the SBP,DBP,HR,SpO2 at preceding anesthesia,5min,10min,15min,30min after anesthesia was observed,and the influence of anesthesia on hemodynamics was evaluated.Results After anesthesia,the SBP,DBP,HR,SpO2 had no significant difference with preceding anesthesia,had no naupathia,sick up and headache.Conclusion The combined spinal-epidural anesthesia has effect on hemodynamic,safe for the elderly patients therapy by hip arthroplasty anesthesia.
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Objective To evaluate the efficacy and safety of single intra-articular etanercept injection in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) who had knee arthritis.Methods This was a randomized, single-blind, parallel, controlled clinical trial. The subjects were the RA or SpA patients with the knee arthritis without deformity, moderate or severe bone erosion and obvious joint space narrowing in radiography in the target knees, who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study. The subjects were randomized in 2:1 ratio to receive either single intra-articular 25 mg etanercept injection or 2 ml compound betamethasone to the target knees joint after their synovial fluid being drawn away at baseline. They were followed up four weeks after injection. The primary end-point was the 4-week change in the modified Hospital for Special Surgery (HSS) knee score for the target knee. Results Forty-seven subjects in the experimental group and twenty-three subjects in the controlled group were included in the trial. The modified HSS knee score for the experimental group was baseline mean 65.6 ± 14.0, follow-up 84.3 ±11.1 (P ＜0.0001 ), the controlled group baseline mean 68.2 ± 11.4, follow-up 79.4 ± 15.5(P =0.0015). A mean (34.9 ±38.9)% improvement on the modified HSS knee score was achieved in the experimental group, while ( 17.9 ±24.5)% improvement on the modified HSS knee score was achieved in the controlled group (P =0.0467). Adverse events were observed in eight patients (19.0% ) in the experimental group and eight patients (44.4%) in the controlled group. No serious adverse event had been observed. Conclusions Single intra-articular 25 mg etanercept injection had a better efficacy than 2 ml compound betamethasone. It was an effective and safe therapeutic option for SpA and RA patients who had knee arthritis without obvious change in radiography.
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Objective To evaluate the efficacy profile of loading dose of anti-tumour necrosis factor (TNF)-α antibody infliximab in the treatment of ankylosing spondylitis (AS) and investigate the parameters that could be used as predicting factors for clinical response to infliximab in AS.Methods This was an open-labeled.mutticenter trial.Subiects eligible for this study were adults with a diagnosis of definite AS.Active disease was a Bath AS disease activity index(BASDAI)≥4 and spinal pain VAS≥4.Infliximab 5 md/kg was infused at weeks 0,2,6.All patients were followed for up to 10 weeks.Logistic regression likelihood ratio tests (univariate and multivariate) were performed to investigate which of the following parameters assessed before treatment were associated with ASAS 20,ASAS 40 and BASDAI 50 response:sex.age.disease duration,HLA-B27,BASDAI,spinal inflammatory (questions 5 and 6 of the BASDAI),spinal pain,night pain,patient global assessment,Bath AS functional index (BASFI),BASMI,enthesis index (EI),presence of peripheral arthritis,chest expansion,ESR,CRP,Bath AS radiology index (BASRI).Results Sixty-three patients (79% were males.90% were HLA-B27 postivie with a median age of 32 years and the median disease duration was 10 years) completed the treatment.The proportion of ASAS 20 responders.ASAS 40 responders and BASDAI 50 at week 10 was 84%,75%,70%,respectively.Univariate and multivariate Logistic regression analysis showed none of the 17 parameters evaluated at week 0 including ESR/CRP,disease duration were predictive for improvement.Conclnsion In this study,a loading regimen of infliximab has demonstrated consistent efficacy and none of the demographic parameters and baseline AS activity parameters are predictors for maior clinical response to infliximab in active AS.
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Objective To improve the understanding of the clinical features, differential diagnosis and prognosis of pachydermodactyly. Methods The clinical data of 20 patients with pachydermo dactyly and follow-up data of 6 patient were analyzed. Results Seventeen out of 20 patients were male. The average onset age was (15±2) years. All of them had asymptomatic, firm swellings which developed insidiously on both sides of the proximal interphalangeal (PIP) joints. All the patients indicated that they were in the compulsive habit of interlacing their fingers and squeezing them. For all patients, biochemical examinations were normal and there was no rheumatoid factor or antinuclear antibodies. X-ray and MRI showed that the thickening of soft tissue around PIP joints without changes in bones or joints structure. Histopathologic findings from the swellings reveMed marked hyperkeratosis, with slight epidermal hyperplasia, and a markedly thickened dermis with whorled, densely aggregated bundles of coarse collagen. Even though 8 patients in the group had gotten rid of the aforesaid habit for 3 to 22 years, the swellings of their PIP joints did not resolve. Conclusion Pachy-dermodactyly is a benign digital fibromatosis which usually involves the PIP joints. It can be distinguished from juvenile rheumatoid arthritis and knuckle pad.
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Objective To improve clinicians' understanding of tuberculosis as the adverse event of the tumor necrosis factor alpha (TNF-α) antagonists therapy. Methods Two rheumatoid arthritis (RA) patients were reported to develop lymphoid tuberculosis and pulmonary tuberculoma after TNF-α antagonists therapy. The relevant literature were reviewed. Results The first ease was a 62 year-old female RA patient. Her skin PPD reaction was negative and chest X-ray was normal before the therapy. Following 4 doses of infliximab injection (each dose of 3 mg/kg) which were completed within 3 months, the patient developed fight supraclavicular lymphoids tuberculosis in the 5th month after the last treatment. The patient completely recovered after lymphoids excision and antituberculosis therapy with 4 anti-tuberculosis medications combination. The second case was a 44 year-old female RA patient. She did not take the skin PPD test and chest X-ray before the therapy. The patient developed fever and chest distress after etanercept therapy (25 mg hypodermic twice per week ) for 1.5 months. The chest X-ray showed a shadow in the median lobe of the right lung, which had gradually developed to a pulmonary tuberculoma. The patient's physical condition improved after the tubereuloma resection. It has been reported in recent years that ① TNF-α antagonists therapy could increase the incidence of tuberculosis, ② the incidence at which infliximab associated tuberculosis was higher than etanercept, ③ the majority of the patient having tuberculosis were old people, and ④ the incidence of extrapulmonary tuberculosis and the disseminated tuberculosis were higher than regular tuberculosis. Conclusion TNF-α antagonists may decrease the host defense ability against mycobacterium tuberculosis and increase the incidence of tuberculosis. The pre-treatment tuberculosis screening, as well as tuberculosis monitoring during and after treatment is mandatory.
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Objective To evaluate the efficacy and safety profile of a recombinant human tumor necrosis factor receptor: Fc fusion protein in ankylosing spondylitis (AS). Methods This was a multicenter,randomized, double-blind, placebo-controlled trial in the first 6 weeks and then followed by an open-labeled trial in the next 6 weeks. One hundred and forty-three patients of active AS were randomly assigned to receive 25 mg twice-weekly subcutaneous injections of rhTNFR:Fc or placebo for 6 weeks. The primary endpoint was proportion of ASAS20 responders at week 6. The secondary endpoints were the proportion of subjects achieving a BASDAI 20%, BASDAI 50% and BASDAI 70% improvement at week 6. Other secondary endpoints, related to reducing signs and symptoms of AS and improving range of motion and physical function, were evaluated.Results Treatment with rhTNFR:Fc resulted in significant improvement. At 6 weeks, 68% of the 71 patients in the rhTNFR: Fc group had a treatment response, as compared with 28% of those in the placebo group(P＜0.01). Improvements over base-line values for other measures of disease activity were significantly greater in the rhTNFR:Fc group, rhTNFR:Fc was well tolerated, The most frequently treatment related adverse event was injection site reaction. Conclusion rhTNFR:Fc has demonstrated consistent evidence of efficacy and is well tolerated in the treatment of active AS.