Clinical characteristics of crystal deposits in joints and tendons in patients with gout / 北京大学学报(医学版)

OBJECTIVE@#To explore the abnormal manifestations and clinical features of patients with gout according to the location of crystal deposits: in articulars or in tendons.@*METHODS@#A total of 105 patients with gout who were continuously treated in the Department of Rheumatology and Immunology of Peking University People's Hospital from June 2019 to December 2019 were selected and their knees, ankles, toes and painful joints and tendons were examined by high-frequency ultrasound. Then we grouped them according to the presence or absence of sodium urate crystals and the location of the crystals, collected their clinical data, and analyzed the clinical characteristics.@*RESULTS@#Among the 105 patients, 25 patients had no crystal deposits in the joints or tendons (as the non-crystal group), 43 patients had intra-articular crystals (as the joint group), and 37 patients had intra-tendon crystals with or without intra-articular crystals (as the tendon group). Among them, the most involved part of sodium urate crystals deposited in the joints was the metatarsophalangeal joint (29 cases, 67.4%), followed by knee joints (10 cases, 23.2%), ankle joints (9 cases, 20.9%). The most involved part of sodium urate crystals deposited in the tendon was the quadriceps tendon (16 cases, 43.2%), followed by the Achilles tendon (13 cases, 35.1%), the patellar tendon (12 cases, 32.4%), and the three heads of brachii tendons (5 cases, 13.5%). The three groups were compared using multi-sample analysis of variance/multi-sample rank sum test. Age, age of first increase in uric acid (UA), serum glucose (Glu) level and C reactive protein (CRP) were all significantly different. After multiple comparisons, compared with the non-crystal group, age, the age of first increase in uric acid, and CRP were significantly higher in the tendon group. There was no significant difference between the non-crystal group and the joint group. There was no significant difference between the tendon group and the joint group.@*CONCLUSION@#In patients with gout, it is common for ultrasound to find crystals deposited in joints or tendons. The most commonly affected parts include the metatarsophalangeal joint, knee joint, ankle joint, quadriceps tendon, Achilles tendon, patellar tendon, and triceps tendon. There were significant differences among the three groups in age, age of first increase in uric acid, CRP and blood glucose, and the proportion of urinary calculi in patients with crystal deposits was significantly higher than those without crystal deposits.

Clinical characteristics and risk factors of cardiovascular disease in patients with elderly-onset rheumatoid arthritis: A large cross-sectional clinical study / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics of patients with elderly-onset rheumatoid arthritis (EORA), and the risk factors of EORA complicated with cardiovascular disease (CVD).@*METHODS@#A cross-sectional study was conducted in Peking University People's Hospital from July 2009 to December 2014 and 1 116 patients were recruited. The patients' characteristics and CVD, including ischemic heart disease, cerebral and peripheral vascular disease, were recorded. The patients were divided into EORA group (n=212) and younger-onset rheumatoid arthritis (YORA) group (n=904) according to the age of onset ≥60 years and < 60 years. Then, the differences between the groups were analyzed by Student's t test, Mann-Whitney U test or χ2test, and risk influencing CVD were analyzed using Logistic regression.@*RESULTS@#There was no significant difference in the disease activity between the EORA and YORA groups. The proportion of male, pulmonary interstitial disease (ILD), and numbers of deformity joint count (DJC) were significantly higher in the EORA group compared with the YORA group [32.1% vs. 18.5%, χ2=19.11, P < 0.001; 23.6% vs. 13.6%, χ2=16.50, P < 0.001; 6 (2, 12) vs. 3 (2, 7), Z=-3.60, P < 0.001], while the prevalence of Sjögren's syndrome was lower than that of the YORA group (13.5% vs. 5.2%, χ2=11.29, P=0.001). Moreover, there were lower prevalences in the patients treated with disease-modifying antirheumatic drugs (DMARDs) in EORA group (35.4%) than in YORA group (26.7%) (χ2=6.43, P=0.011), especially in methotrexate (MTX), hydroxychloroquine (HCQ) and sulfasalazine (SSZ). In addition, the patients with EORA had a higher prevalence of CVD (27.8%) than the YORA group (11.6%, χ2=40.46, P < 0.001), accompanied with higher prevalence of smoking, hypertension, and hyperlipidemia. Multivariate Logistic regression analysis showed that elder age (OR=1.10, 95%CI: 1.00-1.20), DJC (OR=3.17, 95%CI: 1.04-9.68), rheumatoid nodules (OR=3.56, 95%CI: 1.03-12.23), hypertension (OR=2.37, 95%CI: 1.09-5.13) and hyperlipidemia (OR=8.85, 95%CI: 2.50-31.27) were independent risk factors, while HCQ (OR=0.22, 95%CI: 0.07-0.70) and MTX (OR=0.32, 95%CI: 0.14-0.73) were protective factors of EORA complicated with CVD.@*CONCLUSION@#Compared with YORA, patients with EORA have higher ratio of male, ILD and DJC, which may be attributed to inappropriate therapies. EORA is more likely to be complicated with CVD than YORA. Elder age, DJC, rheumatoid nodules, hypertension, and hyperlipidemia are independent risk factors, while HCQ and MTX are protective factors of EORA complicated with CVD.

Clinical characteristics and treatment outcomes of macrophage activation syndrome in adults: A case series of 67 patients / 北京大学学报(医学版)

OBJECTIVE@#To described the clinical and laboratory features and outcome of 67 macrophage activation syndrome (MAS).@*METHODS@#A total of 67 MAS patients from three centers from January 2007 to December 2017 were enrolled. Clinical and laboratory features, and response to therapy were analyzed. Predictive factors for remission and survival were explored.@*RESULTS@#We identified a mean age of (36.1±16.3) years at diagnosis of MAS and a median connective tissue disease (CTD) duration of 8 months prior to MAS development. Among 67 MAS patients identified, underlying diseases included adult-onset Still's disease (AOSD) in 56.7% and systemic lupus erythematosus (SLE) in 30.0%. Fever and splenomegaly were found in 100.0% and 82.1% of the patients, respectively. Ferritinemia and elevation of serum soluble interleukin-2 receptor was seen in 100.0% and 93.2% of the patients. Serum levels of alanine aminotransferase, D-dimer, ferritin and C reactive protein were significantly higher in MAS associated with the AOSD patients than in MAS associated with the SLE patients. A significant decrease of erythrocyte sedimentation rate was found in MAS associated with AOSD, as compared with MAS associated with SLE. The most commonly used therapy was corticosteroids, which were initially administered in 100.0% of the patients. Intravenous immunoglobulin (IVIG) was administered in 91.0%, cyclosporine A in 64.2%, and etoposide in 46.3% of the patients, respectively. The induction therapy yielded a complete remission (CR) at the end of week 8 in 47.8% of the MAS patients. The overall mortality rate at the end of week 16 was 22.4%. The median serum levels of gamma-glutamyltransferase, alkaline phosphatase, total bilirubin and direct bilirubin were significantly lower in the patients who achieved complete remission at the end of week 8 than in those who did not, and splenomegaly was significantly less frequent (71.9% vs.91.4%, P=0.037). Both the mean age at diagnosis of MAS and the mean age at diagnosis of underlying CTD of the deceased patients were elder than those of the survived population (P=0.014 and P=0.017, respectively). The platelet count was significantly less in the deceased population as compared with the living population (P=0.018). No addition of cyclosporine A (P=0.004) was identified as risk factors associated with death in Logistic regression analysis.@*CONCLUSION@#MAS secondary to connective tissue disease is most common with AOSD and SLE. In terms of laboratory findings, there were considerable differences between the patients with underlying SLE and those with AOSD. Advanced age and low platelet counts are significant predictive factors for death, while treatment with cyclosporine may reduce the risk.

Clinical and immunological characteristics of patients with systemic lupus erythematosus in Tibet plateau, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the clinical, immunological characteristics and organ involvement of patients with systemic lupus erythematosus (SLE) in Tibet plateau, China.@*METHODS@#We retrospectively investigated 70 patients admitted in the Tibet Autonomous Region People's Hospital between May 2014 and April 2016. In the study, 120 hospitalized patients with SLE from the Department of Rheumatology and Immunology of the Peking University People's Hospital were randomly selected as the control (plain) group. The major organ involvement, clinical and immunological characteristics were compared between the two groups.@*RESULTS@#The female to male ratio of Tibet plateau group was 10.7, while the corresponding ratio of plain group was 11.0. The mean age at disease diagnosis was (32.21±11.40) and (35.38±13.25) years, respectively. the most common initial manifestations of SLE were arthritis (78.6%), alopecia (55.7%) and malar rash (48.6%) in Tibet plateau group, the prevalence of arthritis and alopecia was significantly higher than in plain group (P<0.05). The incidence of neuropsychiatric and kidney involvement was significantly lower in Tibet plateau group compared with plain group (P<0.05). As for the serological manifestations, the positivity of anti-double-stranded DNA (dsDNA) (57.1%), anti-Smith (Sm) antibody (55.7%), anti-Sjögren syndrome A (SSA) antibody (72.3%), anti-Sjögren syndrome B (SSB) antibody (41.4%) and anti-u1-ribosenuclear protein (u1RNP) antibody (45.7%) was significantly higher in Tibet plateau group (P<0.05). While the incidence of low serum complement C3 (61.4%), C4 (38.6%) less frequent in Tibet plateau group. Mean SLE disease activity index (SLEDAI) score was similar in the Tibet plateau group (12.18±5.58) and plain group (12.69±7.28). Moreover, there were 13 (18.6%) SLE patients suffering from tuberculosis and 7 (10%) SLE patients infected with hepatitis B virus in Tibet plateau group. The number of recent-onset SLE patients with lower 25-dihydroxy-vitamin D3 (25-OH-VD3) in Tibet plateau group was fewer than that in the plain group (76.7% vs. 90.0%, P=0.046). Serum 25-OH-VD3 levels in Tibet plateau plateau group were (31.14±18.74) nmol/L, those in plain group were (26.91±14.27) nmol/L, and the difference was not significant.@*CONCLUSION@#The age, gender and SLEDAI scores in Tibet plateau group was similar to those in plain group. But there are significant differences in clinical manifestations, distributions of antibodies and immunological changes between Tibet plateau group and plain group. The patients with lower serum 25-OH-VD3 levels were more in plain group than in Tibet plateau group, while there was no significant difference in the 25-OH-VD3 level between the two groups.

Study of bone mineral density and serum bone turnover markers in newly diagnosed systemic lupus erythematosus patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the changes of bone mineral density (BMD) and serum bone turnover factor in newly diagnosed systemic lupus erythematous (SLE) patients.@*METHODS@#Eighty newly diagnosed SLE patients and 80 age and gender matched healthy controls were enrolled. None of the SLE patients had ever received glucocorticoid, immunosuppressive agents or vitamin D. BMD was measured at radius,lumbar spine and hip by dual X ray absorptiometry (DXA). Bone turnover markers including serum levels of tartrate-resistant acid phosphatase 5b (TRAP5b),bone alkaline phosphatase (BAP) and 25-hydroxy vitamin D3 (25-OH-VD3) were measured by enzyme-linked immunosorbent assay (ELISA). Logistic regression was employed to analyze the risk factors associated with decreased BMD.@*RESULTS@#Mean age of the SLE patients was (32.8±12.4) years, and 85% were female, none of whom were post-menopausal. BMD was significantly reduced in all the measured sites, compared with the healthy controls. Sixteen (20%) of the patients were osteopenic in at least one site measured locations. The serum levels of 25-OH-VD3 were markedly reduced in the newly diagnosed SLE patients than those of the normal controls [(46.1+12.3) nmol/L vs. (25.4+11.2) nmol/L, P<0.001)]. The serum levels of 25-OH-VD3 in the SLE patients with nephritis were much lower than those without nephritis (P=0.04). A significant negative correlation was demonstrated between the serum concentration of 25-OH-VD3 and the disease activity scores as measured by SLE disease activity index (SLEDAI) (r=-0.3,P=0.001). The serum TRAP5b concentration was positively correlated with SLEDAI (r=0.435,P=0.003). Age (P=0.058) and SLEDAI (P=0.085) were probably associated with decreased BMD in Logistic regression analysis.@*CONCLUSION@#The study showed reduced BMD in untreated SLE patients. The role of chronic inflammation was of probable importance in bone metabolism.

Analysis on management of patients with hypertension in communities in Shanghai / 上海预防医学

Objective To understand the status of community-based management of hypertensive patients aged thirty-five or above in Shanghai . Methods Data from Shanghai Chronic Disease and Risk Factors Surveillance carried out in 2013 were used to analyze the community-based management and treat-ment and control of blood pressure of hypertensive patients aged thirty-five or above in Shanghai .Sample was weighted according to complex sampling scheme and post-stratification to calculate the rates with95 %confidence intervals ( CI) for the subgroups according to different characteristics .The Rao-Scottχ2 test was performed to test for the differences of the rates of the subgroups . Results There were 10 510 hyperten-sion patients were included in the study among which 7 343 patients were aware of their diagnosis , and a total of 3 815 patients had been under management in communities .After being weighted the rate of management of hypertensive patients in communities was 49.74%(95%CI:45.66%-53.83%).There was a significant difference in the proportion of patients receiving management services when comparing different age groups (χ2 =68 .120 , P=0 .002 ) , the rate of management among the patients aged sixty-five or above was 55.49%(95%CI:51.58%-59.32%), while among the patients aged thirty-five to forty-four was only 41.20% (95%CI: 30.73% -52.54%).The rate of management among females was 51.12%(95%CI:47.17%-55.05%), while males was 48.46% (95%CI:43.34%-53.61%), with no statistical significance (χ2 =5.194, P =0.216 ).The rates of management in urban areas , sub-urban areas and rural areas were 47 .66% ( 95%CI: 42 .55%-52 .82%) , 52 .92% ( 95%CI:43.41% -62.24%), 52.84% ( 95%CI: 44.96% -60.58%), respectively, with no statistical significance (χ2 =19 .281 , P =0 .432 ) . The follow-up rate in patients with hypertension under standardized management in communities was 21 .97%( 95%CI: 18 .61% -25 .74%) .There was a significant difference between different genders (χ2 =65.048, P =0.000 ).The rate of females was 27.42%(95%CI:227.7 %-32.61%), which was higher than the rate of males (16.61%,95%CI:13 .02%-209.3 %) .There were no significant differences among different age groups (χ2 =2 .017 , P=0 .834 ) and regions (χ2 =21 .244 , P=0 .111 ) .The treatment rate was 95 .47% ( 95%CI: 94 .08% -96 .54%) .There was a significant difference among different age groups (χ2 =403.46 , P=0 .006 ) .The treatment rate among the patients aged sixty-five or above was 96 .90% ( 95%CI:95 .39%-97 .93%) , while among the patients aged thirty-five to forty-four was 89.31%(95%CI:77.94% -95.19%).There were no significant differences among gender (χ2 =7.983 , P=0.055 ) and regions (χ2 =0.881, P=0 .807 ) .The control rate of hypertensive patients managed in communities was 38 .98% ( 95%CI:35 .55%-42 .51%) , There were no significant differences among different age groups (χ2 =23 .188 ,P=0.103), gender(χ2 =1.050,P =0.468) and regions( χ2 =0.529,P =0.938). Conclusion We should further expand the coverage of the standardized management of hypertension patients in the community , and make personalized intervention plan , so as to improve blood pressure control rates of hypertension patients in the community .

Epidemiology of Diabetes in Adults Aged 35 and Older from Shanghai, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>This study aimed to investigate the epidemiology of diabetes in adults from Shanghai, aged 35 and older, in 2013.</p><p><b>METHODS</b>We estimated the diabetes prevalence in a representative sample of 18,736 adults who were selected through a multistage stratified cluster sampling process. A standard questionnaire containing questions about demographic characteristics and lifestyle factors was distributed. After an overnight fast of at least 10 hours, a venous blood sample was collected from each participant. For each patient without a history of diabetes, another blood sample was drawn 120 min after an oral glucose tolerance test to identify undiagnosed diabetes and prediabetic condition.</p><p><b>RESULTS</b>Among Shanghai residents aged 35 and above, the overall weighted prevalence of diabetes was 17.6% [95% confidence interval (CI): 16.4%-18.8%]. The prevalences were 19.3% in men and 15.8% in women as well as 19.1%, 15.4%, and 16.1% in urban, suburban, and rural residents, respectively. In addition, the weighted prevalence of prediabetes was 16.5% (95% CI: 15.3%-17.8%), with the prevalences of 16.5% in men, 16.6% in women, 15.2% in urban residents, 18.0% in suburban residents, and 18.5% in rural residents. Among all patients with diabetes, 68.1% (95% CI: 64.3%-71.6%) were aware of their status, 63.5% (95% CI: 60.0%-66.9%) received diabetes treatment, but only 35.1% (95% CI: 32.4%-37.8%) had adequate glycemic control.</p><p><b>CONCLUSION</b>In Shanghai, diabetes and prediabetes are highly prevalent. However, 1/3rd of diabetes cases are undiagnosed, and the rate of glycemic control is low.</p>

Awareness of healthy lifestyle content among residents aged 18 -69 years in Shanghai / 上海预防医学

[Objective] To investigate the awareness of healthy lifestyle content among residents in Shanghai and to provide basis for future efforts . [ Methods] Stratified random sampling covered all 18 districts in Shanghai .A total of 8548 participants were recruited and questionnaire with them was completed by face to face interview. [Results] Among Shanghai residents aged 18-69 years, 67.8%of them had awareness of all five items of healthy lifestyle content .And 94.6%, 92.3%, 80.7%, 77.3%, and 81 .7%of them respectively had awareness of balanced diet , regular exercise , no smoking , no alcohol a-buse, and keeping mental balance .Analysis of Logistic regression showed that gender , age, area of resi-dence, and education level were factors influencing awareness rates mentioned above . [ Conclusion] The information about healthy lifestyle content was effectively spread by various departments concerned and the Shanghai government .And the above results suggest that specific information spread for different demo-graphic characteristics of different populations is beneficial for future improvement of healthy knowledge a -mong them.

Study on risk factors and behavior features related to chronic diseases among adults in Shanghai / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the risk factors and behavior features related to chronic diseases among adults in Shanghai.</p><p><b>METHODS</b>A total of 15 516 subjects aged over 18 years old were selected from the investigation project on chronic diseases and relevant risk factors in Shanghai in 2010. Questionnaire were used to investigate the general information of the subjects, such as behavior features as smoking, drinking, diet, physical activity as well as the prevalence and control of chronic diseases as hypertension and diabetes. The physical examination included height, weight, waist circumference, blood pressure, blood glucose and blood lipids.</p><p><b>RESULTS</b>Being preprocessed by complex weighting method, the data showed that the overweight rate of Shanghai adults aged above 18 was 32.4% (5288), separately 32.2% (2506) and 32.5% (2782) (χ(2) = 0.10, P = 0.844) in urban and rural areas; the obesity rate was 8.8% (1538), separately 8.7% (738) and 8.8% (800) (χ(2) = 0.06, P = 0.901) in urban and rural areas. The overweight rate was separately 36.0% (2888) in males and 28.6% (2400) in females (χ(2) = 96.61, P < 0.01); while the obesity rate was separately 8.7% (745) in males and 8.9% (793) in females (χ(2) = 0.06, P = 0.851). Abdominal obesity rate was 44.3% (7419), separately 47.8% (3892) in males and 40.6% (3527) in females (χ(2) = 81.23, P < 0.01), 46.5% (3703) in urban areas and 42.6% (3716) in rural areas (χ(2) = 24.37, P = 0.069). Current smoking rate was 25.0% (3813), separately 48.4% (3722) and 1.2% (91) in males and females (χ(2) = 4572.06, P < 0.01); 23.6% (1609) and 26.0% (2204) in urban and rural areas (χ(2) = 11.92, P = 0.018). The regular smoking rate was 22.1% (3402). The rate of having the habit of drinking at least once a month in males was 39.5% (3102), separately 35.1% (1262) and 42.7% (1840) in urban and rural areas (χ(2) = 45.98, P = 0.012). The rate of drinking almost every day was 16.3% (1380), and the percentage of excessive alcohol consumption was 28.9% (2483). The percentage in group of subjects aging between 45-59 years old was 38.5% (1191), which was higher than that in any other groups (22.8% (641) in group aging 18-44 years old and 22.9% (651) in group aging ≥ 60 years old) (χ(2) = 241.38, P < 0.01). The percentage of over-drinking in rural area was higher than that in urban area, which was 33.5% (1578) and 22.8% (905) respectively (χ(2) = 117.12, P < 0.01). The percentage of once over-drinking was 11.3% (903). It was higher in group aging between 45-49 years old (15.3% (461)) than in other groups (9.0% (222) in group aging 18-44 years old and 8.2% (220) in group aging ≥ 60 years old) (χ(2) = 78.21, P < 0.01). It was also higher in rural area (13.5% (605)) than in urban area (8.3% (298)) (χ(2) = 51.74, P < 0.01). There were 75.0% (11 993) of the Shanghai adults never took physical activity. And the most important problems in dietary habit were insufficient intake of dairy products (98.0%, 15 218), vegetables (53.0%, 7864) and fruits (84.6%, 13 372), excess consumption of sodium (52.0%, 8257) and oil (51.7%, 7884).</p><p><b>CONCLUSION</b>The risk factors of chronic diseases were highly prevalent in Shanghai. The prevalence of risk factors as overweight or obesity, lack of physical activity, smoking, over-drinking and unhealthy dietary habits were higher among adults living in suburban areas than those living in urban areas; the prevalence was also higher among the young adults than that among the elderly people, higher among males than that among females.</p>

Serum IgA against type 3 muscarinic acetylcholine receptor is a novel marker in diagnosis of Sjögren's syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Antibodies against type 3 muscarinic acetylcholine receptor (M3R) are involved in the pathogenesis of Sjögren's syndrome (SS), but the clinical value of them in SS patients has been controversial. The aims of this study were to: (1) establish an improved enzyme-linked immunosorbent assay (ELISA) to detect IgA antibodies against M3R; (2) evaluate the value of IgA antibodies against the second extracellular loop of M3R205-220 (c2M3RP) in diagnosis of SS.</p><p><b>METHODS</b>To increase the ELISA sensitivity, c2M3RP was coupled to bovine serum albumin (BSA) by the glutaraldehyde method and a 96-well microplate was treated by ultraviolet rays before coated. Concentrations of anti-c2M3RP, anti-SSA, and anti-SSB were measured in the sera of 240 individuals: 91 patients with primary SS and 149 controls (16 secondary SS, 27 systemic lupus erythematosus, 40 rheumatoid arthritis and 66 healthy controls). Diagnostic properties of anti-c2M3RP were determined by receiver-operating characteristic curve analysis.</p><p><b>RESULTS</b>The prevalence of serum IgA anti-c2M3RP antibodies in patients with pSS (46%, 42/91) was significantly higher than that in patients with systemic lupus erythematosus (19%, 5/27), in rheumatoid arthritis (15%, 6/40) and in healthy controls (5%, 3/66). However, there was no significant difference between the two SS groups (P = 0.727). The diagnostic performance of IgA anti-M3RP antibodies was similar to anti-SSA assay, but had 22% higher sensitivity than anti-SSB. By analyzing of IgA anti-c2M3RP antibodies, combination of anti-SSA and anti-SSB resulted in increased sensitivity, whereas their specificity was not significantly changed.</p><p><b>CONCLUSIONS</b>The improved anti-c2M3RP ELISA is a novel, sensitive, and specific serological test for the diagnosis of SS. The combined application of anti-c2M3RP, anti-SSA and anti-SSB tests can improve the laboratory diagnosis of SS. The IgA anti-c2M3RP antibodies may serve as a novel diagnostic marker for SS.</p>