Clinical analysis of 9 cases of thymoma in sy stemic lupus erythematosus / 中华风湿病学杂志

Objective Thymoma is associated with autoimmune diseases. We retrospectively analyzed the clinical characteristics of thymoma complicated systemic lupus erythematosus (SLE). Methods Patients were from Qilu Hospital Shandong University between June 2004 and June 2014, and satisfied classification criteria of American College of Rheumatology (ACR) classification criteria 1997 for SLE. Thymoma was diagnosed by chest CT scan. Results Nine cases were of thymoma complicated with SLE, with the male:female ratio of 1∶8. The age of SLE onset was (48±19) years, age of thymoma discovery was (47±19) years. The follow-up period was 3 to 10 years. Three cases (33%) were benign thymoma and underwent thymectomy and verified by histopa-thology test. One case presented thymoma 9 years after SLE, 5 cases (56%) presented SLE and thymoma simultaneously, 3 cases (33%) presented SLE after thymectomy. Clinical manifestations of SLE included 4(44%) skin lesions, 8(89%) polyarthritis, 5(56%) nephritis, 3(33%) leukocytopenia, 3(33%) throm-bocytopenia, 2 (22%) of interstitial pneumonia, 4 (44%) pleural effusion, no neuropsychiatric systemic lupus erythematosus. Nine cases (100%) were ANA positive, 7 (78%) were anti-dsDNA positive. Conclusion SLE complicated thymoma usually occurs in relatively older age, tend to present with multi-systemic presentations, and high percentage of anti-dsDNA positivity.

Olfactory function and related factors in systemic lupus erythematosus / 中华风湿病学杂志

Objective To investigate the olfactory function in patients with systemic lupus erythematosus (SLE) and to explore factors that may influence it.Methods The Connecticut Chemosensory Clinical Research Center (CCCRC) test was carried out in SLE patients and healthy controls for olfactory function testing.ELISA method was used to detect anti-ribosomal P protein antibody in the serum.The statistical methods used in this study including t test,ANOVA,LSD-t test,Pearson correlation analysis,multiple linear regression analysis,andx2 test.Results ① The CCCRC scores of the active,inactive group and healthy controls were compared,the difference was statistical significant (F=26.52,P=0.01).CCCRC score in active SLE group (62±16) was lower than that of the inactive group (80±13) the and the normal control group (83±12) (P＜0.01),while there was no statistical significant difference between the inactive group and the normal controls (P=0.226).② CCCRC score was lower in 16 ARPA positive SLE patients (61±17) than 49 negative patients (74±16) (t=2.681,P=0.009).③ In addition,CCCRC score showed a negative correlation with ARPA serum concentration (r=-0.327,P=0.008).There was no significant correlation between CCCRC score and disease course (r=0.141,P＞0.05).④ Multiple linear regression analysis indicated that CCCRC score was associated with age and ARPA.Conclusion SLE patients have olfactory dysfunction and the dys-function is associated with age and ARPA.

Ultrasound investigation of peripheral joints in early rheumatoid arthritis / 中华风湿病学杂志

Objective To evaluate the value of high-frequency color Doppler ultrasound in the examination of pathological changes in the peripheral joints of patients with early rheumatoid arthritis (RA).Methods Peripheral joints of 30 consecutive patients with early rheumatoid arthritis (disease duration ＜1year) and 15 healthy volunteers were assessed with ultrasound searching for joint effusion,synovial hypertrophy,tendon lesion and bone erosions.The joints examined including bilateral elbows,wrists,knees,ankles,metacarpophalangeal joints (MCP),proximal interphalangeal joints (PIP) and metatar-sophalangeal joints (MTP).Data were analyzed with t-test and kappa test.Results Joint effusion and/or synovial hypertrophy were found in 471 joints (41.3％).Four hundred and four (35.4％) joints had joint effusion,359(31.5％) had synovial hypertrophy.Power Doppler signals were found in 128 (35.7％) joints with synovial hypertrophy.Periarticular tendon lesions were found in 90(25％) joints of all wrists,ankles and the 2nd to 5th metacarpophalangeal joints.Bone erosions were detected in 27 (2.4％) joints.The most likely involved joint in all peripheral jints was wrist which had the highest positive rate of effusion,synovial hypertrophy,bone erosion and power Doppler signals in the synovial membrane.Other joints which were easily involved with synovitis were knee,ankle,elbow,MTP,MCP and PIP.The positive rate of synovitis was highest in the MTP of all small joints exception the wrist.Synovitis present most frequently in the 2nd MCP of all MCPs,the 3rd PIP of all PIPs and the 2nd MTP of all MTPs.The kappa coefficient between clinical examination and ultrasound in the detection of peripheral joints synovitis was 0.21,showing very poor agreement.Conclusion High-frequency color Doppler ultrasound exa.mination is an effective method in assessing the pathological changes of peripheral joints of patients with early rheumatoid arthritis.It may improve the early diagnosis of RA and useful in assessing disease activity comprehensively.

The clinical study on the risk of permanent hair dye use for connective tissue disease with positive antinuclear antibodies / 中华风湿病学杂志

Objective To investigate the risk of permanent hair dye use for connective tissue disease ( CTD ) with positive antinuclear antibodies ( ANA ).Methods We conducted a population-based case-control study to analyze 440 CTD patients from the department of our hospital.Four hundreds and forty patients' relatives or friends who were free from any CTD were selected as controls.Patients and controls were matched in sex and age.A face-to-face interview was adopted to finish questionnaires about subjects' demographic data and the use of permanent hair dye.Data about the duration,frequency,times of usage and allergy related to hair dye were collected.Medical history was also reviewed,such as the diagnosis,disease course,primary symptoms,serum tests and organ involvements.Statistical analysis was performed by SPSS 17.0 software using x2 test and Logistic regression.Results The association between the use of permanent hair dye and CTD did not reach statistical significance (OR=1.282,95％CI 0.966-1.700,P=0.085 ),when the relationship of hair dye use with systemic lupus erythematosus (SLE) was tested,the same result (OR=1.092,95％CI 0.795-1.500,P=0.587 ) could be revealed.Conclusion This preliminary study has shown that the use of permanent hair dye couldn't induce the occurrence of CTD.

A multicenter study of fracture in patients with rheumatoid arthritis in China / 中华风湿病学杂志

ObjectiveTo examine the clinical features of fractures and related risk factors in patients with rheumatoid arthritis(RA) in China.MethodsSix hundred and eighty-one RA patients were randomly selected from department of rheumatology of 18 hospitals of China.Data were obtained from the questionnaire,including age,sex,disease duration,the involvement of joints,treatment regimen,features of fractures etc.The possible risk factors of fracture in patients with RA were analyzed with a multi-variate Logistic regression analysis.Results① In 681 RA patients of the survey,48 patients had 54 fractures,and the incidence of fractures was about 8％.② Fractures occurred at various sites.Foot/ankle,femur,spine and wrist were the mostfrequent sites.③ The Logistic regression analysis showed that several factors increased the risk of fracture in RA patients,including long disease duration (OR:1.245,95％CI:0.987-1.570,P=0.065),male gender(OR:0.433,95％CI:0.199-0.942,P=0.035),more deformed joints(OR:1.042,95％CI:1.006-1.079,P=0.023),family history of RA (OR:2.201,95％CI:0.984-4.923,P=0.055),and high scores of SF-36(OR:1.017,95％CI:1.002-1.033,P=0.028).④ According to the degree of correlation from strong to weak,the risk factors of fracture were disease duration,SF-36,sex,number of deformed joints and family history of rheumatoid arthritis.ConclusionThe incidence of fracture is high in patients with rheumatoid arthritis.Several factors could increase the risk of fractures in RA patients,including long disease duration,male gender,more deformed joints,and family history of RA.In order to prevent the occurrence of fractures,cautions should be taken to prevent the development of fractures and treat the disease aggressively to suppress the disease activity of RA.

Establishment and evaluation of classification criteria for early rheumatoid arthritis / 中华风湿病学杂志

Objective To establish new classification criteria for early rheumatoid arthritis (E-RA) based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China.Methods Patients who had arthritic complaints with disease duration less than one year were enrolled.They were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The clinical and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria.Statistical analysis was carried out by using t test,x2 test and Logistic regression.Results ① A total of 803 patients with early inflammatory arthritis were included in this study.Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases,and the diagnosis of 38 patients remained unestablished by the end of follow-up.② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity.The sensitivity of the new E-RA criteria was 84.4％,which was higher than 1987 ACR criteria (58.0％),while the corresponding specificities were similar,which were 87.4％ and 93.6％ respectively.③ Compared with the complex scoring system of 2010 ACR/EULAR criteria,the E-RA criteria was more simple and practical.The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures.④ New classification criteria based on scoring system using Logistic regression analysis was established.The sensitivity of this criteria was 86.4％,which was higher than 1987 ACR criteria (58.0％).Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria,and is more simple than 2010 ACR/EULAR criteria.It may be used as a new classification criteria for early RA diagnosis.

A multicenter, double-blind, randomized, placebo-controlled clinical trial of etanercept treatment of Chinese patients with active ankylosing spondylitis / 中华内科杂志

ObjectiveTo evaluate the efficacy and safety of etanercept 50 mg once-weekly treatment of Chinese patients with active ankylosing spondylitis ( AS).Methods Four hundred patients with active AS,enrolled in six medical centers,were randomly divided into either the treatment group or the placebo group in a 3∶1 ratio.The total length of the study was 12 weeks.The first 6-week period was a double-blind placebo controlled treatment period and the second 6-week period was an open-labeled treatment period.During the first 6-week period,300 patients in the treatment group received once-weekly subcutaneous injection of etanercept (50 mg),whereas the 100 patients in the placebo group received placebo injection.During the second 6-week period,patients in both groups received etanercept (50 mg once weekly subcutaneous injection).The primary end point was the percentage of patients achieving the Assessments in Ankylosing Spondylitis (ASAS) 20％ response ( ASAS 20 ) at week 6.Other outcome measures included the percentage of patients achieving ASAS 5/6,partial remission and Bath AS disease activity index 50 ( BASDAI 50) responses at week 12.ResultsA total of 381 patients completed the trial,including 285 patients in the etanercept group and 96 patients in the placebo group.At week 2,the percentage of patients achieving ASAS 20 in the etanercept group was 55.7％,whereas the placebo group was only 17.0％ ( P ＜ 0.001 ).At week 6,77.5％ of patients in the etanercept group achieved ASAS 20 as compared with 32.3％ in the placebo group ( P ＜ 0.001 ).At the end of 12 weeks,the percentage of patients in the etanercept group achieving the ASAS 20 was 89.5％.Improvements of other measures were also significant in the etanercept group.Etanercept was well tolerated and no malignancy and life-threatening events were observed in this study.Most adverse events observed were mild injection-site reactions.ConclusionEtanercept 50 mg weekly treatment of Chinese patients with active ankylosing spondylitis is convenient,fast-acting,highly effective,and well tolerated.

Evaluation of the clinical and radiological.efficacy of recombinant human TNFR Ⅱ -Fc combined with methotrexate in the treatment of moderate and severe rheumatoid arthritis / 中华风湿病学杂志

ObjectiveTo evaluate the clinical and radiological efficacy of TNFR Ⅱ -Fc combined with methotrexate( MTX ) in treatment of patients with moderate and severe rheumatoid arthritis.MethodsThree hundred and ninty-six RA patients were randomized into the combined treatment group,the TNFR Ⅱ -Fc only group and MTX only group.All patients were treated for 24 weeks.ACR-N,ACR20,ACR50,ACR70,DAS28-ESR and Sharp score of both hands were measured for efficacy,and the side-effects were analyzed by one-way ANOVA.Results After 24-week therapy,the ACR-N of the combined treatment group [( 12.79±9.24)％-year] was significantly improved than that of the TNFR Ⅱ-Fc only group [(9.56±11.16)％-year,P＜0.05] and that of the MTX only group[(5.08±11.10)％-year,P＜0.05],and the TNFR Ⅱ-Fc group was significantly improved than that of the MTX group(P＜0.05).The ACR20 response rate of the combined group(80.4％) was significantly higher than that of the TNFR Ⅱ -Fc group(71.1％,P＜0.05) and the MTX group(56.7％,P＜0.01 ).The ACRS0 response rate of the combined group(53.6％) was significantly higher than that of the MTX group(30.8％,P＜0.01 ).The ACR70 response rate of the combined group was 27.7％,which was significantly different from that of the TNFR Ⅱ -Fc group (15.8％) and MTX group (7.7％,P＜0.05or P＜0.01 ).DAS28-ESR in the combination group was significantly reduced than those of the TNFR Ⅱ -Fc group and MTX group,and the DAS28-ESR of the TNFR Ⅱ -Fc group was significantly reduced than MTX group.The average total Sharp score of both hands,which demonstrated the radiographic changes,was significantly reduced in the combination group than the MTX group(P=0.03).The total adverse events in the combined group(40.9％) was significantly high than that of the MTX group(28.8％,P＜0.05).Conclusion TNFR Ⅱ -Fc combined with MTX can effectively control the activity of RA and radiological progress.

The expression and significance of T cell immunoglobulin domain and mucin domain-3 and its ligand Galectin-9 in the peripheral blood of initial systemic lupus erythematosus patients / 中华风湿病学杂志

Objective To investigate the expression of T cell immunoglobulin domain and mucin domain (TIM)-3 and its ligand Galectin-9 in the peripheral blood of initial systemic lupus erythematosus (SLE)patients,and explore their effects on SLE.Methods The percentages of CD4+TIM-3+,CD8+TIM-3+cells from 33 SLE patients and 26 normal controls were detected by flow cytometry,and the Galectin-9 gene expression of PBMCs was determined by real-time PCR The SLE Disease Activity Index(SLEDAI),C3 level and lymphocyte count were evaluated.Mann-Whitney U test was used for independent samples analysis and Spearmen's test was used for correlation analysis.Results The percentages of CD4+TIM-3+ and CD8+TIM-3+ cells were markedly increased in SLE group than those of the control group(P<0.01).In particular,the CD4+TIM-3+,CD8+TIM-3+ level Was positively correlated with SLEDAI (r=0.517,P＜0.01;r=0.400,P＜0.05);but negatively correlated with C3(r=0.487,P＜0.05;r=0.395,P＜0.05).The Galectin-9 mRNA in SLE PBMCs was higher than that of the controls(P<0.05).Conclusion TIM-3-Galectin-9 pathway may be involved in T cell immune regulation of SLE,and is related to disease activity.

NEURONAL MIGRATION AND SYNTHESIS OF PEPTIDIC NEUROTRANSMITTERS IN CO-CULTURES OF NODOSE GANGLIA AND CARDIAC MYOCYTES / 神经解剖学杂志

To investigate the neuronal migration and synthesis of peptidic neurotransmitters in vitro, neuromuscular co-cultures of nodose ganglia and cardiac muscle cells of Wistar rats were established. The living cells of co-cultures were observed with an inverted contrast microscope at different culture age. At 72 h and 96 h of culture age, the neuromuscular co-cultures were examined by Holmes' reduced silver staining technique for observing the neuronal migration. Immunohistochemical staining method was used for investigating the synthesis of peptidic neurotransmitters- substance P (SP) and calcitonin gene-related peptide (CGRP). The neuronal morphorlogical maturation in neuromuscular co-cultures seems at 72 h of culture age in terms of the observation of living cells and Holmes' reduced silver staining technique. SP- and CGRP-immunoreactive neurons were observed in neuromuscular co-cultures at 96 h of culture age but not 72 h. The results indicate that the neuronal morphological maturation can not represent the maturation of neurotransmitter synthesis. The synthesis of neurotransmitters is not maturated in the neuromuscular co-cultures until 96 h of the culture age.

Association between rheumatoid arthritis and shared epitope of HLA-DRB1 gene in Shandong population / 中华风湿病学杂志

Objective To investigate the association between rheumatoid arthritis (RA) and the presence of the shared epitope (SE) of HLA DRB1 gene in Han nationality of Shandong population.Methods The method of DNA amplification with sequence specific primers (PCR SSP) was used to determine 17 alleles of HLA DRB101,04,10 genotypes in 132 RA patients and 130 healthy controls from the Han nationality population in Shandong.Results The frequencies of SE were significantly increased in RA patients compared with controls (50 0% vs 22 3%, P

Quality of life of 151 patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective To determine health related quality of life (QOL) of patients with systemic lupus erythematosus (SLE) and to identify the factors affecting QOL. Methods One hundred and fifty-one consecutive patients with SLE were separated into different groups according to the type or stage of disease. Health status were measured by 1 health transition (HT) and 8 composite scales of the medical outcomes study short form-36 (SF-36). The mean scores for each subscale of the SF-36 for patients with SLE in China were compared to those of a health population in China and of foreign SLE patients.The effect of patients′age,sex,education level,disease duration,disease activity (assessed by SLEDAI score),and organ damage(assessed by SLICC/ACR DI) and treatment were analyzed. ANOVA, rank sum test and correlation analysis were applied for statistical analysis. Results Patients with SLE had significantly lower HT and mean scores in each subscale of the SF-36 compared to those of a health population in China,while the scores in such subscales as physical functioning (PF), bodily pain (BP), vitality (VT), role-emotional (RE) and mental health (MH) were higher than those of foreign SLE patients. The mean scores of those patients with lupus nephritis and center neural lupus or in active state were lower than those not or those in steady-going. The SLEDAI score and SLICC/ACR DI were the most important elements that affected the QOL in SLE patients and showed obviously negative correlated with one′s scores in SF-36. The glucocorticoid dose of patients was closely negatively correlated with one′s scores. The latter were also associated with age, education level and disease duration. Conclusion The health status of patients with SLE is mainly associated with disease activity,damage and therapy. The SF-36 is a valid instrument for measuring the health related QOL in SLE.

Effects of injecting the colloidal chromic phosphate ~(32)P into articular cavity on arthritis in rats / 中华风湿病学杂志

Objective To evaluate the efficiency of injection of colloidal chromic phosphate 32 P cavity in rats with rheumatoid arthritis.Methods Collagen induced arthritis (CIA) was produced in Sprague Dawley rats.After one week immune,the right post ankle was given colloidal chromic phosphate 32 P intra articular injection.Severity of arthritis was observed by the left to right diameter of the right post ankle joint,the volume of right post paw and the arthritic index.Results The group treated with colloidal chromic phosphate 32 P intra articular injection developed milder arthritis compared with control CIA group after 6 weeks.The left to right diameter of the right post ankle joint was (3 96?0 05) mm of the colloidal chromic phosphate 32 P intra articular treated group compared with (4 11?0 08) mm of the control CIA group ( P