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OBJECTIVE To investigate the clinical efficacy and safety of rituximab （RTX） followed by belimumab （BLM） in patients with severe systemic lupus erythematosus（SSLE）. METHODS Nine SSLE patients， who were treated with RTX followed by BLM for more than 6 months in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Zhengzhou University from October 2020 to June 2021， were enrolled. Baseline clinical data of patients， laboratory examination results and basic treatment status at weeks 0， 4， 12， and 24 of medication were collected retrospectively. The patients’ systemic lupus erythematosus disease activity index （SLEDAI） score， glucocorticoid dosage and serological indicators （complement C3， complement C4， serum albumin， and 24-hour urine protein quantification） level were analyzed. At the same time， the occurrence of adverse drug reaction was collected. RESULTS All 9 patients completed more than 24 weeks of RTX followed by BLM therapy. All patients suffered from renal impairment， of which 7 （77.8%） had renal pathology support， 3（33.3%） had blood system damage and 2 （22.2%） had nervous system damage. During treatment， with the prolongation of treatment time， the SLEDAI score， 24- hour urinary protein quantification， and glucocorticoid dosage of patients showed a significant downward trend， and ultimately decreased to the normal index level （P＜0.05）； serum albumin， complement C3 and complement C4 all showed a significant upward trend， eventually rose to the normal index level （P＜0.05）. During treatment and follow-up， 1 patient developed herpes zoster， 1 patient developed upper respiratory tract virus infection， and 1 patient developed urinary system bacterial infection. All patients recovered after symptomatic treatment. CONCLUSIONS In sequential use of RTX followed by BLM for SSLE， early administration of RTX can quickly stabilizethe condition， significantly alleviate clinical symptoms， and gradually normalize specific serological indicators； subsequent administration of BLM can reduce the type and dosage of basic treatment drugs； there is no increase in the incidence of adverse drug reactions.
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Objective To investigate the serum levels of dickkopf-related protein 1 (DKK1) and sclerostin (SOST) in patients with axial spondyloarthritis treated with selective cyclo-oxygenase 2 inhibitor and its relation to clinical efficacy.Methods A randomized double-blind controlled trial with axial spondyloarthritis (ax-SpA) was carried out in our hospital.The data from patients in a single center was collected and analyzed.Serum DKK1 and SOST levels were measured by enzyme-linked immuno sorbent assay (ELISA)method before and after 12 weeks treatment,then correlation analysis were conducted for DKK1 and SOST levels with erythrocyte sedimentation rate (ESR),C reactive protein (CRP),Bath ankylosing spondylitis disease activity index (BASDAI),Bath ankylosing spondylitis functional index (BASFI) and SPARCC of the sacroiliac joint inflammation score.Chi-square tests were used for analyzing of categorical data.Fisher exact tests were performed when the expected frequencies were less than 5.Two independent samples t-test was used to compare the difference between groups.Single sample t-test was used to ompare the differences between data before and after treatment.Pearson or Spearman correlation was used for correlation analysis.Results After 12 weeks of treatment,a total of 116 patients completed the follow-up,including 57 cases of imrecoxib group and 59 cases of the celecoxib group.There were no statistically significant difference between the two groups (P＞0.05).The level of serum DKK1 was significantly increased after treatment [(393±137) pg/ml,vs (542±274)pg/ml,P＜0.05].The serum level of SOST increased significantly [(39±19) pg/ml vs (57±36) pg/ml,t=5.814,P＞0.05],too.The difference between the two groups was not statistically significant (P＞0.05).Spearman correlation analysis showed that serum DKK1 was positively correlated with serum SOST (r=0.226,P=0.015).A significantcorrelation was found between SOST level and ESR,CRP,finger to floor distance,left and fight lumbar side flexion and Schober's test (ESR:r=-0.379,P＜0.01;r=-0.309,P=0.001;r=-0.225,P=0.015;r=0.185,P=0.047;r=0.247,P=0.008;r=0.214,P=0.021).Conclusion Imrecoxib and celecoxib have similar efficacy on relieving the signs and symptoms of patients with ax-SpA.Short-term application of selective COX-2 inhibitors can increase DKK1 and SOST and possibly delay radiographic progression.
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Objective:To evaluate the changes of quality of life in patients with axial spondyloarthritis (ax-SpA) after treatment with non-steroidal anti-inflammatory drugs (NSAIDs) by the 36-item Short Form Health Survey (SF-36).Methods: 120 patients diagnosed with ax-SpA were collected in the first Affiliated Hospital of Zhengzhou University from October 2014 to September 2015.They all agreed to be treated with the special drugs and assessed by special scale.Then they all signed the agreement.In the 3 months,double-blind,parallel controlled trial patients were randomized to 200 mg twice daily (bid) imrecoxib,or 200 mg twice daily (bid) celecoxib.They were assessed for the changes of quality of life at enrollment and after three months of NSAIDs therapy by the SF-36 of Chinese edition.The correlation between quality of life and erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),Bath Ankylosing Spondylitis Disease Activity Index (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI),Spondylo Arthritis Research Consortium of Canada (SPARCC) was analyzed.Results: A total of 116 ax-SpA patients completed the study and 4 patients were lost to follow-up.We used the SF-36 scale to assess the quality of life in patients with ax-SpA before and after 3 months,NSAIDs treatment.The treatment effects were not statistically significant difference between the two drugs (P>0.05).After all the patients were treated with NSAIDs for 3 months,there was statistically significant difference (P0.05) of vitality and mental health.The positively significant correlations had been identified between BASDAI and PF,RP,BP,GH,VT,SF,RE (P0.05).A positively significant correlation had been identified between BASFI and PF,RP,BP,GH,SF,RE,MH (P0.05).The ESR was positively correlated with SF,RE (P<0.05);and CRP was positively correlated with SF,MH (P<0.05);and SPARCC was positively correlated with PF (P<0.05).BASDAI and BASFI were the important influence factors of PF (P<0.05);and BASDAI was the important influence factor of BP,GH,VT,RE(P<0.05);BASFI was the important influence factor of RP,SF,MH(P<0.05).Conclusion: Non-steroidal anti-inflammatory drugs can improve the quality of life of the ax-SpA patients.Imrecoxib and celecoxib have the equivalent curative effect.SF36 scale is suitable for the assessment of the quality of life in patients with ax-SpA.
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Objective To analyze the clinical characteristics of respiratory involvement in relapsing polychondritis(RPC). Methods The clinical data of 38 patients with respiratory (larynx, trachea and bronchus) involvement in RPC were retrospectively analyzed. Results The incidence of respiratory involvement in patients with RPC was 51.35%(38/74), and the most common symptoms were cough, wheezing, chest tightness and dyspnea. The incidences of erythrocyte sedimentation rate (ESR) increasing, C- reactive protein (CRP) increasing, fibrinogen increasing, D- dimer increased and rheumatoid factor (RF) positive in patients with respiratory involvement were significantly higher than those in patients without respiratory involvement: 47.37% (18/38) vs. 30.56% (11/36), 52.63% (20/38) vs. 33.33% (12/36), 31.58% (12/38) vs. 25.00% (9/36), 21.05% (8/38) vs. 13.89% (5/36) and 36.84%(14/38) vs. 5.56% (2/36), and there were statistical differences (P<0.05). CT was the main method to discover the respiratory involvement, and MRI could detect early cartilage inflammation lesions. Laryngoscope and bronchoscope could early detect mucosa and cartilage damage. Pathology was given priority to lymphocytes and neutrophils infiltration. Some patients had epithelium metaplasia and even canceration. Primary treatment methods were glucocorticoids combined with immunosuppressant. Airway stenosis and infection was the main factors influencing the prognosis of patients. Conclusions The respiratory involvement is not uncommon in RPC, and early CT, MRI, laryngoscope and bronchoscope examination is an important means of early diagnosis.Early glucocorticoid combined immunosuppressive therapy is the key to achieve good prognosis.
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Objective To investigate the incidence and correlative factors of metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE).Methods A total of 116 SLE patients and 115 controls were enrolled into the study.The incidence of MS,SLE disease activity index(SLEDAI) of patients with SLE combined with MS (MS-SLE) and patients without MS (n-MS-SLE),lupus characteristics,cumulative glucocorticoids,administration dose of glucocorticoids and hydroxychloroquine were compared between SLE group and the control group.Results The incidence of MS of SLE group was obviously higher than that of the control ( 34.48％ vs 14.78％,P ＜ 0.05 ).The ratios of patients with lower HDL-C,higher TG and higher blood pressure in SLE group ( 50.86％,56.03％,46.55％ ) were higher than those in the controls ( 34.78％,16.52％,20.00％,all P ＜ 0.05 ).MS-SLE group had significantly higher mean waist circumference,BMI,systolic blood pressure and diastolic blood pressure and lower HDL-C than n-MS-SLE group (all P ＜0.05 ).No significant difference was found regarding duration of disease,renal involvement,ESR,C-reactive protein,high-sensitivity C-reactive protein,SLEDAI,cumulative and current glucocorticoids use in MS-SLE group and n-MS-SLE group.The ratio of patients taking hydroxychloroquine in n-MS-SLE group was higher than that of MS-SLE group (46.05％ vs 15.00％,P＜0.05).Conclusions Patients with SLE has a higher incidence rate of MS.Hydroxychloroquine may reduce their MS incidence.
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Objecfive To investigate the clinical characteristics,treatment and prognosis of autoimmune diseases associated and non-autoimmune diseases associated hemophagocytic syndrome.Methotis Clinical records of 15 cases witll secondary hemophagocytic syndrome'were collected and the relations with treatment and prognosis was analyze.The similarities and differences between autoimmune disease associated bemophagocytic syndrome (group A)and non-autoimmune disease associated hemophagocytic syndrome (group B)were compared.Fisher exact test,t test and Willcoxen test were used for statistical analysis.Results Both groups had fever,bleeding,jaundice,hepatosplenomegaly,and arthralgia,skin rash and positive of autoantibodies in group A were discovered specifically.But in group B,the patients with icterus were mo common(38% vs 100%,p=0.018).There was no significant difference in their laboratory data and prognosis when compared between the two groups(P>0.05).The patients who received corticosteroids and IVIG and/or immunosuppressive agents had better prognosis(P<0.05).Conclusion Except for icterus there is no significant difference in clinical features and laboratory data among autoimmune disease associated hemophagocytic syndrome and other secondary hemophagocytic syndrome.And the therapy with corticosteroids combined with IVIG and/or immunosupprcssive agents is effective.
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Objective To observe the effect of recombinant human tumor necrosis factor receptor-Fc fusion protein (rhTNFR-Fc, etanercept) on the expression of transforming growth factor-β1 (TGF-β1) in bleomycin induced interstitial lung disease of rats. Methods Forty-five male Sprague-Dawley (SD) rats were randomly divided into three groups (control group, model group and rhTNFR-Fc treatment group, 15 rats in each), on the 7th, 14th and 28th days, five rats of each group were killed. The lungs were incised to make pathological sections which were stained with HE and Masson, and the expression of TGF-β1 was detected by immunohistochemical technique. Results There was no collagen deposition, alveolitis and fibrosis changes in the control group. The alveolitis and fibrosis of the treatment group was less severe than that in the model group (P<0.01). The expression of TGF-β1 in the model group was significantly higher than that in the control group (P<0.01). In the 7th and 14th days, the expression of TGF-β1 in the treatment group was signific-antly higher than that in the control group (P<0.01). Although that in the 28th day was a slightly higher but no statistical significance (P>0.05) could be detected. In the treatment group, the expression of TGF-β1 was lower in the 7th day (P>0.05) and was significantly lower in the 14th and 28th days than that in the model group (P<0.01). Conclusion Recombinant human tumor necrosis factor receptor-Fc fusion protein can alleviate the severity of alveolitis and pulmonary fibrosis induced by Bleomycin-A5 in rats, which may be due to the inhibition of TGF-β1 overexpression.
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Objective To study the characteristic and management method of steroidogenic diabetes in patients with rheumatic disease. Methods The follow-up data of steroidogenic diabetes in 38 patients with rheumatic disease were analyzed retrospectively. Results The nosogenesis of steroidogenic diabetes and fast blood sugar level was related with steroid dosage, using time, age, obesity and hypertipoidemia. The blood-fasting sugar level was not so obviously increased. Blood sugar at bedtime was (24.40±5.92)mmol/L,before breakfast was (9.52±3.64)mmol/L, after breakfast was (20.38±7.19)mmol/L, before lunch was(10.69±3.23)mmol/L, after lunch was (21.81±6.92) mmol/L, before dinner was (12.17±3.63)mmol/L. There was significant difference between blood sugar at bedtime and that in others (P<0.01 or<0.05). Most patients needed insulin to control blood sugar. Decreasing the daily dosage of steroid might be beneficial to the reduction of corticosteroid induced diabetes. Most patients could stop insulin injection when the daily dosage of steroid decreased to a certain level. Conclusions The prescription of corticesteroid in rheumatic diseases can cause temporal increase of blood sugar. Intensive follow-up aad blood sugar monitor is important for the diagnosis of steroidogenic diabetes. Promptly administration of insulin is required for blood sugar control.