A double-blind, double-dummy, randomized controlled, multicenter trial of 99Tc-methylene diphosphonate in patients with moderate to severe rheumatoid arthritis / 中华医学杂志(英文版)

BACKGROUND@#Clinical observational studies revealed that 99Tc-methylene diphosphonate (99Tc-MDP) could reduce joint pain and swollenness in rheumatoid arthritis (RA) patients. This multicenter, randomized, double-blind, double-dummy study aimed to evaluate the effects of 99Tc-MDP plus methotrexate (MTX) vs. MTX alone or 99Tc-MDP alone on disease activity and structural damage in MTX-naïve Chinese patients with moderate to severe RA.@*METHODS@#Eligible patients with moderate to severely active RA were randomized to receive 99Tc-MDP plus MTX (n = 59) vs. MTX (n = 59) alone or 99Tc-MDP (n = 59) alone for 48 weeks from six study sites across four provinces in China. The primary outcomes were the American College of Rheumatology 20% improvement (ACR20) response rates at week 24 and changes in modified total Sharp score at week 48.@*RESULTS@#At week 24, the proportion of participants achieving ACR20 was significantly higher in the MTX + 99Tc-MDP combination group (69.5%) than that in the MTX group (50.8%) or 99Tc-MDP group (47.5%) (P = 0.03 for MTX + 99Tc-MDP vs. MTX, and MTX + 99Tc-MDP vs.99Tc-MDP, respectively). The participants in the MTX + 99Tc-MDP group and the 99Tc-MDP group had significantly less important radiographic progression than the participants in the MTX group over the 48 weeks (MTX + 99Tc-MDP vs. MTX: P = 0.03, 99Tc-MDP vs. MTX: P = 0.03, respectively). There was no significant difference in terms of adverse events (AEs) among the groups. No serious AEs were observed.@*CONCLUSIONS@#This study demonstrated that the combination of 99Tc-MDP with MTX inhibited structural damage and improved disease activity in RA patients compared with MTX and 99Tc-MDP monotherapies, without increasing the rate of AEs. Additional clinical studies of 99Tc-MDP therapy in patients with RA are warranted.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR-IPR-14005684; http://www.chictr.org.cn/showproj.aspx?proj=10088.

Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis / 中华医学杂志(英文版)

BACKGROUND@#Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.@*METHODS@#We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.@*RESULTS@#A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ = 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ = 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ = 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803-55.938; P < 0.001).@*CONCLUSION@#As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.

Efficacy and Safety of Tofacitinib in Chinese Patients with Rheumatoid Arthritis / 中华医学杂志(英文版)

Background@#Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This study assessed the efficacy and safety of tofacitinib in Chinese patients with RA enrolled in Phase 3 and long-term extension (LTE) studies.@*Methods@#ORAL Sync was a 1-year, randomized, placebo-controlled, Phase 3 trial. Patients received tofacitinib 5 or 10 mg twice daily (BID) or placebo advanced to tofacitinib 5 or 10 mg BID at 3 or 6 months. All patients remained on ≥1 background conventional synthetic disease-modifying antirheumatic drug. ORAL Sequel is an open-label LTE study (data-cut: March 2015; data collection and analyses were ongoing, and study database was not locked at the time of analysis; study was closed in 2017). Efficacy outcomes: American College of Rheumatology (ACR) 20/50/70 response rates and Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-4 [ESR]). Patient- and physician-reported outcomes: Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient and Physician Global Assessment of Arthritis, and pain (visual analog scale). Safety was assessed throughout.@*Results@#ORAL Sync included 218 patients; 192 were subsequently enrolled into ORAL Sequel. In ORAL Sync, more patients achieved ACR20 (tofacitinib 5 mg BID, 67.4%; 10 mg BID, 70.6%; placebo, 34.1%) and DAS28-4 (ESR) <2.6 (tofacitinib 5 mg BID, 7.1%; 10 mg BID, 13.1%; placebo, 2.3%) with tofacitinib versus placebo at Month 6. Mean changes from baseline in HAQ-DI were greater with tofacitinib versus placebo at Month 6. In ORAL Sequel, efficacy was consistent to Month 48. Incidence rates for adverse events of special interest in tofacitinib-treated patients were similar to the global population.@*Conclusions@#Tofacitinib significantly reduced signs/symptoms and improved physical function and quality of life in Chinese patients with moderate-to-severely active RA up to Month 48. The safety profile was consistent with the global population.@*Clinical Trial Identifier@#NCT00856544 and NCT00413699.

Studies on chemical constituents of Acroptilon repens / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the chemical constituents of Acroptilon repens.</p><p><b>METHOD</b>The ethanol extract of A. repens was isolated and purified by means of chromatography. These compounds were identified by their spectral data.</p><p><b>RESULT</b>11 compounds were isolated and identified as 2alpha, 9beta-dihydroxy-dehydrocostus lactone (1) , cynaropicrin (2) , apigenin (3) , stigmasterol (4) , 4' -hydroxywogonin (5) , ethyl caffeate (6) , p-methoxy-cinnamic acid (7) , luteolin (8) , daucosterol (9) , apigenin-7-O-beta-D-glucoside (10) , syringin (11).</p><p><b>CONCLUSION</b>Compounds 5-11 were isolated from A. repens for the first time. Compound 1 is new compounds.</p>

Studies on flavonoid constituents from herbs of Artemisia ordosica II / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents of herbs of Artemisia ordosica.</p><p><b>METHOD</b>The chemical constituents were isolated and repeatedly purified on silica gel column and the structures were elucidated by the NMR spectra and physicochemical properties.</p><p><b>RESULT</b>Eight flavones were obtained and they were identified as isosakuranetin, 7, 4'-dimethylaro madendrin, acacetin, cirsimaritin, rhamnetin, eupatolin, 5, 7, 2', 4'-tetrahydroxy-6, 5'-dimethoxyflavone, hyperoside.</p><p><b>CONCLUSION</b>All the compounds were obtained from herbs of A. ordosica for the first time.</p>

Studies on chemical constituents in herb of Chondrilla piptocoma / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents of Chondrilla piptocoma.</p><p><b>METHOD</b>The chemical constituents were isolated and repeatedly purified on silica gel column and the structures were elucidated by the NMR spectra and physico-chemical properties.</p><p><b>RESULT</b>Seven compounds were obtained and they are identified as luteolin, 5,7,4'-trihydroxy-3'-methoxy flavone, luteolin-7-O-beta-D-glucoside, apigenin, beta-sitosterol, stigmasterol, ursolic acid.</p><p><b>CONCLUSION</b>All the compounds were obtained from C. piptocoma for the first time.</p>

Studies on flavonoids from herb of Artemisia ordosica / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents of Artemisia ordosica.</p><p><b>METHOD</b>The chemical constituents were isolated and repeatedly purified on silica gel column and the structures were elucidated by the NMR spectra and physico-chemical properties.</p><p><b>RESULT</b>Eight flavonoids were obtained and identified as 5-hydroxy-7, 4'-dimethoxyflavanone, 5-hydroxy-7, 4'-dimethoxyflavone, 5, 4'-dihydroxy-7-methoxyflavone, 5, 7-dihydroxy-6, 4'-dimethoxyflavone, 5, 4'-dihydroxy-7-methoxyflavanone, 5, 3', 4'-trihydroxy-7-methoxyflavanone, 5, 7-dihydroxy-3', 4'-dimethoxyflavone and 5, 3', 4'-trihydroxy-7-methoxyflavone.</p><p><b>CONCLUSION</b>All the compounds were obtained from A. ordosica for the first time.</p>

Studies on the alkaloids from herb of Corydalis adunca / 中国中药杂志

<p><b>OBJECTIVE</b>To study the alkaloid constituents of Corydalis adunca.</p><p><b>METHOD</b>The constituents were isolated on silica gel column and their structures were elucidated by IR, NMR, MS data.</p><p><b>RESULT</b>Four alkaloid compounds were isolated from alcohol extract of the herb of C. adunca, and identified as tetrahydropalmatine, 1, 2, 3, 4-tetrahydro-6-methoxy-1-(4'-methoxyphenyl) methyl-7-isoquinolinol, coptisine and palmatine.</p><p><b>CONCLUSION</b>Four compounds were isolated from C. adunca for the first time.</p>

Misdiagnosis analysis of POEMS syndrome and its early diagnosis / 第二军医大学学报

Objective:To study the causes of misdiagnosis of patients with POEMS syndrome and to discuss the clues for its early diagnosis.Methods:The clinical and laboratory data of 26 inpatients with POEMS syndrome,who were treated in Changhai hospital over the last decade,were retrospectively analyzed.Results:The misdiagnosis rate of our group was 100%. The misdiagnosis was made in(3.31?0.97)hospitals and in(3.31?0.93)clinical departments;the misdiagnosis period was (19.42?10.86)months and it had been misdiagnosed as 18 other diseases.The initial symptoms included polyneuropathy in 21 (80.8%)cases,edema of lower extremity in 22(84.6%)cases,and body weight loss in 8(30.8%)cases.The typical clinical symptoms included polyneuropathy in 26(100%)cases and organomegaly in 24(92.3%).Two cases had newly-identified uterine hypertrophy,one had adrenal gland hypertrophy,and one had gastric wall thickening mimicking advanced gastric cancer.Hypothyroidism,impotence,skin pigmentation and sclerosis occurred in 76.9%(20/26),60%(6/10),92.3%(24/ 26)and 65.4%(17/26)cases,respectively.Monoclonal plasma cell proliferation was documented in 18(81.8%);M proteins were positive in 14(63.6%)cases by serum immunofixation,and only 2(9.1%)cases also positive by serum protein electrophoresis.One patient was positive of M protein by urine immunofixation and one had abnormal infiltration of plasma cells in the gastric wall.Lymph node biopsy were performed in 8 patients and 3 were found to have Castleman disease;the other 5 cases had lymphocyte infiltration,with 3 complicated with plasma cell proliferation.Nerve biopsy in 4 cases all revealed axonal degeneration and one patient complicated with demyelination.Bone marrow biopsy in 5 cases revealed plasmacytosis in 2 cases and myeloma in one.Excessive radioactivity resorption was found in 10 of the 16 cases(62.5%)and abnormal plasma cells were detected in 2 cases by bone aspiration guided by radioisotope bone scan.Conclusion:Misdiagnosis of POEMS syndrome is very common.Polyneuropathy,edema of lower extremity and body weight loss are the common early symptoms of POEMS syndrome. Early diagnosis can be made by having an intimate knowledge of the progression of the disease and by detecting M protein through various approaches.