Recommendations for the medication of rheumatic diseases in periconceptional period / 中华内科杂志

Rheumatic diseases are a kind of chronic inflammatory diseases mainly involving joints and surrounding tissues. Most patients with rheumatic diseases need long-term treatment, which is difficult to be avoided during pregnancy. Treatment efficacy, as well as maternal and fetal safety should be taken into account in the medical decision. Based on the domestic and foreign guidelines, consensus, diagnosis and treatment experience, Chinese Rheumatology Association developed the standardization of medication use in patients with rheumatic diseases preparing and during pregnancy, aiming on the application and precautions of commonly used medicines for rheumatic diseases in preparing pregnancy, pregnancy and lactation.

Recommendations of diagnosis and treatment of primary Sj?gren′s syndrome in China / 中华内科杂志

Sj?gren′s syndrome is a chronic systemic autoimmune disease characterized by lymphocyte proliferation and progressive exocrine gland damage. In China, standardized diagnosis and treatment for Sj?gren′s syndrome lags behind other common rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Based on the evidence and guidelines from China and other countries, Chinese Sj?gren′s Syndrome Collaborative Research Group together with stomatologist and ophthalmologist developed Standardization of diagnosis and treatment of primary Sj?gren′s syndrome. The purposes are: (1) to standardize the detection and interpretation of key indicators for the diagnosis of Sj?gren's syndrome, including serum anti SSA antibody and labial gland pathology; (2) to suggest using widely accepted disease activity index in evaluation of the disease; (3) to standardize rational management for Sj?gren′s syndrome patients with topical and systemic diseases.

Analysis of relevant factors in systemic lupus erythematosus patients with venous thromboembolic ;disease / 中华风湿病学杂志

Objective To explore the risk factors and clinical features of systemic lupus erythematosus (SLE) patients with venous thromboembolic disorders (VTE). Methods Twenty SLE patients with VTE (VTE group) and 40 SLE cases without VTE (control group) were retrospectively analyzed for clinical and laboratory features. T test, Mann-Whitney U rank sum test, χ2 test, Logistic regression analysis were used for statistical analysis. Results The prevalence of VTE in SLE patients was 1.5%(20/1 326). Renal involvement, increased blood pressure, history of lower extremity deep vein catheter, merging with antiphospholipid antibody syndrome (APS) could be seen more frequently in VTE group than control group ( χ2=5.508, 7.033, 5.208, 7.882, respectively), and the difference were statistically significant (both P<0.05). Hydroxychloroquine dosage used in the VTE group (133±119) mg/d was lower than that of the control group (211±126) mg/d (t=2.156, P=0.034), antiplatelet drug use rate was lower than the control group too, the difference were statistically significant ( χ2=7.080, P=0.008). Logistic regressions showed that renal involvement [OR=5.5, 95%CI (3.6, 12.7), P=0.003], lower C3 level [OR=2.3, 95%CI (1.8, 5.2), P=0.005], SLEDAI activity score [OR=8.13, 95%CI (5.2, 7.3), P=0.001] were independent risk factors for VTE in SLE. Conclusion SLE patients with renal involvement, increased blood pressure, history of lower extremity deep vein catheterization or complicated with APS were risk factors for VTE, while hydroxylchloroquine, antiplatelet drugs may help prevent VTE.

Churg-Strauss syndrome involving large-and medium-sized arteries: report of six cases and review of literature / 中华风湿病学杂志

Objective To summarize the clinical manifestations and treatment of Churg-Strauss syndrome (CSS) involving large and medium-sized arteries. Method Six cases were investigated retrospec-tively and literature were reviewed. Results The pathological category of large-and medium-sized arteries involved in CSS included occlusion, stenosis, thrombesis, dissection, aneurysm, arteritis, and periarterifis. The involved arteries included coronary artery, central retinal artery, mesenteric artery, vertebral artery, basilar artery, carotid artery, aorta, and arteries of extremities. The large-and medium-sized arteries involvement in patients with CSS might not associated with age, duration of disease, and the titer of perinuclear-antineutrophil cytoplasmic antibodies. Treatment with corticosteroid and immunosuppressive agents combined with surgical interventions or anticoagulation if needed might improve the prognosis in the early stage. It was particularly hazardous for coronary involvement in patients with CSS. Conclusion CSS can involve many kinds of large-and medium-sized arteries. The pathological category of large and medium-sized arteries involved in CSS is diverse. More attention should be paid to large and medium-sized arteries involvement in patients with CSS.

Predictors of maternal and fetal outcome in systemic lupus erythematosus: a retrospective study of 94 cases / 中华内科杂志

Objective To evaluate the predictors of maternal and fetal outcome of pregnancy for systemic lupus erythematosus(SLE)patients.MethodsNinety-four patients with 96 pregnancies which were evaluated retrospectively from Jan 1990 to Jan 2008 in Peking Union Medicai College Hospital were divided into two groups:disease stable during pregnancy(group A)and lupus flares during pregnancy (group B).Statistical analysis was performed by X2 or Fisher exact test and Student's t-test.A binary logistic regression model was used to evaluate the predictors of matemal and fetal outcome.Results There were 36 pregnancies with stable lupus disease(group A)and 60 pregnancies with lupus flares(group B).of the 96 pregnancies.18 resulted in therapeutic abortion and 7 in fetal loss,71 resulted in a live birth,3 in neonatal death.The rates of preterm delivery,small gestational age(SGA)and neonatal asphyxia in group B were higher than those in group A(P＜0.05).By binary logistic regression analysis,preeclampsia/eclampsia low serum platelet count and SLE flares were associated with poor fetal outcome(β=2.463,2.228.2.769 respectively.P＜0.05).,rhere were 56 pregnancies with stable lupus disease at the conception with 22(39.3%)occurred lupus flares during pregnancies.Twenty-four preeclampsia and 2 eclampsia were seen in all the pregnancies.Fifty-two pregnancies were complicated with lupus nephritis,and 25 pregnancies(48.1%,25/52)of which were disease stable at the conception,and among 22 pregnancies with disease stable over one year.twelve of which occurred lupus nephritis flares.Three pregnancies which have disease activity within one year before pregnancy all occurred lupus nephritis flares.There were four maternal death which all occurred at the postpartum.By binary logistic regression analysis,lupus nephritis flares were associated with preeclampsia/eclampsia(B=2.658,P＜0.05),and proteinuria at the conception before dilivery were significantly associated with SLE flares(13=3.263,P＜0.05).Conclusion An increase of fetal loss,preterm delivery,SGA and neonatal asphyxia was seen in patients with lupus flares during pregnancy compared with those with stable disease.About 1/3 lupus activity may increase after pregnancy.Preeclampsia and eclampsia were increased when there were lupus nephritis flares.

Contrast media induced apoptosis in renal tubular cells via the activation of p38 mitogen-activated protein kinase / 中华肾脏病杂志

Objective To investigate whether the effect of contrast media on renal tubular cell apoptosis is mediated via mitogen activated protein kinase(MAPK) activation. Methods NRK 52E cells were incubated in cell culture media[+1%fatel calf serum (FCS)] containing buffer (control) or increasing concentrations of diatrizoate or iohexol for various time periods. In separate experiments, NRK 52E cells were incubated with diatrizoate in the presence of 10 or 20 ?mol/L SB203580, an inhibitor of p38 MAPK, for 4 h. Cell membrane integrity was assessed by trypan blue exclusion experiment. Apoptosis was assessed by flow cytometric DNA analysis, FITC Annexin Ⅴbinding/PI staining and electron microscopy. MAPK activity and phosphorylation was evaluated by immunoprecipitation and Western blot analysis. Results Diatrizoate, a kind of hyperosmolal contrast media, induced apoptosis in cultured NRK 52E cells in an osmotic pressure and duration dependent manner. Iohexol, another kind of less hyperosmolal contrast media, could not induce NRK 52E cells apoptosis. In NRK 52E cells incubated with diatrizoate, the level of p38 MAPK phosphorylation and activity increased after 15 min, and remained elevated even at 1 h. In contrast, the level of total p38 protein was not changed in whole experimental period. SB203580 significantly inhibited apoptosis in NRK 52E cells incubated with diatrizoate. The level of p44/p42 MAPK phosphorylation was not changed in whole experimental period. Conclusions Contrast media induces apoptosis in cultured NRK 52E cells in an osmotic pressure and duration dependent manner, which is related to the hypertonicity of contrast media. Contrast media induces apoptosis in NRK 52E cells via activation of p38 MAPK.