Clinical characteristics, ultrasonic diagnosis, treatment and outcomes of eosinophilic fasciitis: a retrospective single-center analysis of 45 cases / 南方医科大学学报

OBJECTIVE@#To evaluate the clinical features, laboratory and imaging results, treatment and outcomes of eosinophilic fasciitis (EF) and assess the value of ultrasound in the diagnosis of EF.@*METHODS@#We retrospectively analyzed the clinical data of 45 patients with EF treated in our center from January 1, 2006 to February 28, 2022. The consistency between the diagnoses of EF based on ultrasound and MRI findings was assessed.@*RESULTS@#In the 45 EF patients (male/female ratio 3.5:1), the age of onset ranged from 16 to 64 years with a mean disease course of 22.6 months. The average time from symptom onset to diagnosis was 16 months. The most common possible trigger of the disease was vigorous exercise (10/45), causing symmetrical lesions in the limbs, most commonly in the forearms (86.7%) and lower legs (80%). Clinical features of EF included subcutaneous swelling and induration (95.6%), arthralgia and arthritis (55.6%), groove sign (42.2%), hand joint contractures (42.2%), skin pigmentation (37.8%), and peau d'orange appearance (13.3%). Eosinophilia was found in 31 patients (68.9%). Hypergammaglobulinemia was seen in 23/44 (52.3%) and positive antinuclear antibodies in 9 (20%) of the patients. Twentyone of the patients were treated with high-dose methylprednisolone (≥200 mg daily for 3 to 5 consecutive days), and compared with the patients who did not receive this treatment, these patients more frequently experienced relapse before admission, had more extensive involvement, and had a higher rate of hypergammaglobulinemia without fever, but these differences were not statistically significant. Of the 31 patients (68.9%) with follow-up data (for a median of 3.2 years [range 0.2-15.9]), complete remission was achieved in 12 (38.7%) patients, and the accumulative complete remission rate was 44.1% at 5.5 years. No specific baseline characteristics or immunosuppressants were found to correlate with the treatment response. A total of 26 patients underwent both ultrasound and MRI examination, and the Kappa value of the diagnostic results between ultrasound and MRI was 0.91.@*CONCLUSION@#EF is characterized by symmetrical subcutaneous swelling and induration in the limbs, accompanied by eosinophilia and hypergammaglobulinemia. Glucocorticoid is effective for treating EF. Ultrasound examination can identify thickening of subcutaneous fascia for an early diagnosis of EF.

A new method to evaluate hip joint damage in ankylosing spondylitis / 中华风湿病学杂志

Objective In order to assess the structure damage of hip joint in ankylosing spondylitis (AS), a new radiograph-based scoring method was developed according to the radiological characteristics of hip involvement in AS, as well referring to prior existing scoring indexes. Methods A new scoring method consti-tuted of erosion, sclerosis and joint space narrowing was developed, pelvis anterior-posterior plain films acquired from patients with AS at baseline and follow-up were collected and assessed by two physicians who were trained in image reading by radiologists. All films were scored independently and blindly. Intra- and inter-reader reliability were assessed by intra-class correlation coefficient (ICC), the feasibility of this new scoring method was assessed by the mean time acquired to score a plain (two hips), its ability to detect the change of structure damage was assessed by the comparison of score differences between baseline and different follow-ups. The date were analyzed by paired-t test or nonparametric tests. Analysis of Variance (ANOVA) or nonparametric tests were utilized for the comparison of means of quantitative variables among the three groups, while Chi-square test for rates of categorical variables. Results No statistically significant differences existed in demographic data and suspected risk factors among the three groups at baseline (P>0.05). Intra-observer reliability was good (0.84 and 0.89), as well as the inter-observer reliability (0.72), the mean time needed to score was (33 ±10) seconds. Score changes were not statistically significant in the groups with follow-up duration of 1-2 and 3-4 years, but in the group of over 5 years, baseline/final scores assessed by the two observers were (6.0±2.7/7.5±3.7) and (5.6±2.1/7.1±3.6), respectively, both changes were statistically significant (t=2.86, Z=-2.99; P<0.01). Conclusion This new method is not only reproducible and easy to operate in clinic practice, but also can tell the changes of hip joint structure damage in the interval of over 5 years, further validation is requeired to demonstrate its discriminability in large populations.

A multi-center cross-sectional survey of medicine application in patients with osteoarthritis in China / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics, the medicine application and to evaluate the disease activity in patients with osteoarthritis (OA) in China.@*METHODS@#This was a cross-sectional study. Totally 1 066 cases of OA from 40 hospitals in China from April to October 2017 were retrospectively enrolled. Demographic characteristics, clinical data, medicine application, and joint function were evaluated. All the data were analyzed by SPSS software 19.0. t test, Mann-Whitney U test and chi-square test were used for statistical analysis.@*RESULTS@#In the 1 066 cases, the male-to-female ratio was 1:3.6 and the average age was (61.9±11.0) years, with an age range from 36 to 94 years. The incidence of knee OA, hip OA, and hand OA were respectively 81.9% (873/1 066), 14.1% (150/1 066), and 36.3% (387/1 066). In the study, 242 (22.7%) cases had two kinds of joint areas involved and three joint areas were involved in 51 cases (4.8%), and 56.6% (603/1 066) of the patients used more than one kind of non-steroid anti-inflammatory drugs (NSAIDs) while 61.2% (652/1 066) used disease modifying osteoarthritis drugs (DMOADs), including glucosamine (37.5%, 400/1 066), chondroitin sulfate (2.0%, 21/1 066), diacetate (5.9%, 63/1 066), and the combination of these drugs (15.8%, 168/1 066). 8.6% (92/1 066) patients only took analgesics to relieve the pain, not using any kind of NSAIDs or DMOADs. And 232 patients (21.7%) had intra-articular injections, including 9.2% (98/1 066) sodium hyaluronate, 4.5%(48/1 066) glucocorticoid, and 8.1% (86/1 066) combination of the two drugs. The proportion of the patients taking topical drugs accounted for 26.5% (283/1 066) and physical therapy accounted for 15.8% (168/1 066). Compared with those who suffered from knee OA, the patients who suffered from hip OA had more severe disease assessment. Moreover, there were significant differences in pain (Z=-7.625, P<0.001), morning stiffness (Z=-6.229, P<0.001), and joint function (Z=-6.777, P<0.001) between the two groups of the patients who suffered from knee or hip OA with The Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. Furthermore, patients with hip OA took more analgesics (χ2=24.838, P<0.001).@*CONCLUSION@#Oral NSAIDs and DMOADs are wildly used in patients with OA in China. However, the treatment of some patients still need to be improved. Patients with hip OA are more seriously ill and require aggressive treatment.

Academic level assessment of randomized controlled trial abstracts in papers on budesonid adjuvant therapy for children pneumonia / 中华医学图书情报杂志

Objective To assess the academic level of randomized controlled trial abstracts in papers on budesonid adjuvant therapy for children pneumonia and analyze its influencing factors. Methods The randomized controlled tri-al abstracts in papers on budesonid adjuvant therapy for children pneumonia were assessed according to the CON-SORT 2010 Statement and were statistically analyzed using the RevMan 5 . 3 . Results The items with a low reporting rate of the randomized controlled trial abstracts in the 282 papers included in this paper were "title judged as ran-dom","communication author","randomized","blind method","randomized grouping cases","fund-suppor-ted". Hierarchical analysis showed that the number of words in abstracts played an important role in affecting the reported items. Conclusion The academic level of randomized controlled trial abstracts in papers on budesonid adju-vant therapy for children pneumonia is significantly different from that of the abstracts in clinical papers according to the CONSORT 2010 Statement. Researchers should thus use the CONSORT 2010 Statement-defined items in writing their papers in order to improve the academic level and readability of their abstracts.

Clinical characteristics of urticaria in children versus adults / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of urticaria in children versus adults, and to provide reference for the etiological analysis, disease evaluation, and treatment of urticaria in children.</p><p><b>METHODS</b>The clinical data of 2 411 patients with urticaria who visited the Department of Dermatology at Xiangya Hospital of Central South University from January 2013 to May 2017 were collected to study their socio-demographic characteristics. The clinical characteristics of urticaria were compared between the 68 children and 672 adults of the 740 patients with complete follow-up data.</p><p><b>RESULTS</b>Among the 411 pediatric patients, 314 (76.4%) had acute urticaria; among the 2 000 adult patients, 896 (44.8%) had chronic spontaneous urticaria. The causes of acute urticaria in children included infection (41%, 16/39). The accompanying symptoms of acute urticaria in children mainly included abdominal pain and diarrhea (44%, 17/39), while those in adults mainly included chest distress and shortness of breath (32%, 11/34). Compared with the adult patients, the pediatric patients had significantly lower chronic urticaria activity scores before and after treatment (P<0.05), a significantly higher rate of response to second-generation antihistamines (82.1% vs 62.2%; P<0.05), and a significantly higher proportion of individuals with a personal and family history of urticaria (P<0.05).</p><p><b>CONCLUSIONS</b>Acute urticaria is more commonly seen than chronic urticaria in children with urticaria, and the main accompanying symptoms are abdominal pain and diarrhea, which are different from adults with urticaria. Chronic urticaria has a better treatment outcome in children than in adults. The most frequently seen cause of acute urticaria is infection in children. Atopic children may be susceptible to urticaria.</p>

Advance in studies on antioxidant activity of propolis and its molecular mechanism / 中国中药杂志

Propolis is an adhesive substance mixed with plant resins collected by honeybees (Apis mellifera) and secretions from their mandibular gland and wax gland, with wide pharmacological activity and healthcare functions. Its antioxidant activity has long been regarded as one of the most important biological activities of propolis. This article summarizes studies on the antioxidant activity of propolis extracts from different geographic origins and with different extraction methods, as well as several important monomer active ingredients in propolis, and concludes the potential molecular mechanism of antioxidant activity of propolis and its monomer ingredients, with the aim of providing ideas for further studies on pharmacological activity of propolis, as well as reference for in-depth development of propolis products.

Inhibitory effect of human umbilical cord-derived mesenchymal stem cells on interleukin-17 production in peripheral blood T cells from spondyloarthritis patients / 中国实验血液学杂志

In this study, the inhibitory effect of human umbilical cord-derived mesenchymal stem cells (hUCMSC) on interleukin-17 (IL-17) production in peripheral blood T cells from patients with spondyloarthritis (SpA) were investigated, in order to explore the therapeutic potential of hUCMSC in the SpA. Peripheral blood mononuclear cells (PBMNC) were isolated from patients with SpA (n = 12) and healthy subjects (n = 6). PBMNC were cultured in vitro with hUCMSC or alone. The expression of IL-17 in CD4(+) T cells or γ/δ T cells were determined in each subject group by flow cytometry. IL-17 concentrations in PBMNC culture supernatants were measured by ELISA. The results indicated that the proportion of IL-17-producing CD4(+) T cells and IL-17-producing γ/δ T cells of SpA patients were 4.5 folds and 5 folds of healthy controls [CD3(+)CD4(+)IL-17(+) cells (3.42 ± 0.82)% vs (0.75 ± 0.25)%, P < 0.01; CD3(+)γδTCR(+)IL-17(+) cells (0.30 ± 0.10)% vs (0.06 ± 0.02)%, P < 0.01]. After co-culture of PBMNC in patients with hUCMSC, the increased proportions of CD3(+)CD4(+)IL-17(+) cells and CD3(+)γδTCR(+)IL-17(+) cells in SpA patients were inhibited significantly by hUCMSC [CD3(+)CD4(+)IL-17(+) cells (3.42 ± 0.82)% vs (1.81 ± 0.59)% (P < 0.01); CD3(+)γδTCR(+)IL-17(+) cells (0.30 ± 0.10)% vs (0.16 ± 0.06)% (P < 0.01]. In response to phytohemagglutinin (PHA, 1 µg/ml), PBMNC from SpA patients secreted more IL-17 than that from healthy control [(573.95 ± 171.68) pg/ml vs (115.53 ± 40.41) pg/ml (P < 0.01)]. In the presence of hUCMSC, PBMNC of SpA patients produced less amount of IL-17 [(573.95 ± 171.68) pg/ml vs (443.20 ± 147.94) pg/ml, (P < 0.01)]. It is concluded that the IL-17 production in peripheral blood T cells from SpA patients can be inhibited by hUCMSC, which have therapeutic potential for SpA.

Clinical analysis of childhood acute generalized exanthematous pustulosis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To describe the etiology, clinical features and treatment of childhood acute generalized exanthematous pustulosis (AGEP).</p><p><b>METHODS</b>Clinical data from 20 cases of childhood acute generalized exanthematous pustulosis from 1990 to 2008 were retrospectively reviewed.</p><p><b>RESULTS</b>Eighteen cases had a history of medication, including the use of penicillin (n=6), cephalosporins (n=3), sulphonamides (n=2), algopyrin (n=2), vaccines (n=2 ) and anti-cold drugs (n=3). Fever and generalized erythematous pustules were observed in all 20 cases. Histopathologic examination revealed spongiform superficial pustules and papillary edema. The patients were asked to stop taking suspected sensitizing drugs and received glucocorticoid treatment (1-2 mg/kg daily). After 3-5 days of the treatment, symptoms were improved and the dosage of glucocorticoid was gradually reduced. All patients were healed within 20 days after treatment.</p><p><b>CONCLUSIONS</b>The cause of AGEP is mainly attributed to the use of antibiotics, sulphonamides, antipyretic analgesics and vaccines in children. AGEP is characterized by fever and widespread pustular eruption of the skin. Removal of sensitizing factors and glucocorticoid administration is important in the treatment of AGEP in children.</p>

Evaluation of efficacy and safety of diacerein in knee osteoarthritis in Chinese patients / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of diacerein in patients with knee osteoarthritis (OA).</p><p><b>METHODS</b>A total of 223 patients satisfying the American College of Rheumatology criteria for knee OA were chosen for this 17-week, randomized, double-dummy, diclofenac sodium-controlled trial, with diacerein dosage of 100 mg/d and diclofenac sodium of 75mg/d. Efficacy and safety of both drugs were evaluated.</p><p><b>RESULTS</b>Totally 106 patients in the diacerein group and 107 patients in the diclofenac group were considered qualified for the evaluation. After 12 weeks of treatment, the total effective rates of patients/physicians' overall assessment in diacerein and diclofenac groups were 65.4%/61.6% and 61.2%/61.2%, respectively (P > 0.05). The primary efficacy parameter [visual analog scale (VAS) assessment of pain on 20 metres walking] and the secondary efficacy parameters [tenderness on palpation, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-item Short-Form (SF-36) Health Survey] significantly improved compared with baseline in both groups (P < 0.05). In the follow-up period, there were no obvious changes in above parameters in diacerein group. However, in diclofenac group, pain on 20 metres walking, tenderness on palpation, and WOMAC became aggravated after withdrawing the drug for 4 weeks (P < 0.05). Moreover, the consumption of paracetamol was significantly lower in diacerein group than in diclofenac group during follow-up (P < 0. 001). The incidences of related adverse events were 35.7% in diacerein and 45.1% in diclofenac group, respectively. Mild-to-moderate gastrointestinal disorders were the most frequent adverse events.</p><p><b>CONCLUSIONS</b>Diacerein is as effective as diclofenac sodium in treating patients with knee OA. Furthermore, it has better extended effect and a good safety profile. It is generally well tolerated and has no severe adverse effect.</p>

Clinical analysis and follow-up years of 63 palindromic rheumatism patients / 中华风湿病学杂志

Objective This research is proposed to improve the recognition of the clinical features, therapy and prognosis of palindromic rheumatism.Methods We analyzed the clinical data of 63 palindromic rheumatism patients.Their response to therapy was observed,and they were followed up for 1.5 to 3 years. Results The average onset age of the patients was(40?11)years and the average disease duration was(8?7) years.They were characterized by recurrent attacks of sudden-onset acute arthritis and(or)periarticular tis- sue inflammation,in which most joints were involved.In 46 percent of the patients,the attacks were incited by some events.In 67 percent of them,the attacks recurred more and more frequently.Nonsteroidal anti-in- flammatory drugs and disease modifying anti-rheumatic drugs(DMARDs)was effeeive in variant extents,to palindromic rheumatism patients.Five percent of patients achieved complete remission.Nine percent of them had relapses for a long time.And 5% of them evolved to RA.Conclusion Palindromic rheumatism is a syn- drome characterized by recurrent attacks of sudden-onset acute arthritis and(or)periarticular tissue inflam- mation.The therapy of DMARDs,especially penicillamine and chloroquine diphosphate,is effective on the syndrome.The outcomes of palindromic rheumatism is diverse.

Risk of tuberculosis in rheumatoid arthritis and ankylosing spondylitis patients treated with tumor necrosis factor antagonists / 中华风湿病学杂志

Objective To study the risk of tuberculosis (TB) infection in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients before and after treated with tumor necrosis factor (TNF) antago- nists.Methods RA and AS patients treated with TNF antagonists infliximab and etanercept between 2003 and 2006 were followed up for the risk of TB infection.The protein purified derivative (PPD) test and chest anteroposterior and lateral view X-ray were done at screening for all these patients.Results Among 67 RA patients screened,1 was PPD positive.One patient developed right supraclavicular lymph node TB 4 months after study completion.Among 203 AS patients screened,27 patients were PPD positive,2 had calcified pul- monary TB foci and 2 had pulmonary TB.PPD positive rates and calcified TB foci or active TB found in RA and AS patients screened were significantly lower than national TB infection rates and prevalence (P＜0.01). Conclusion In this short-term clinical observation,increased risk of TB infection was not found after TNF antagonists treatment in RA and AS patients.However,it is necessary to screen patients for signs of TB infec- tion before TNF antagonists treatment.

ASAS20 at week 2 predicts subsequent improvement as well as the rate of relapse of ankylosing spondylitis infused with three pulses of infliximab / 中华风湿病学杂志

Objective To evaluate the clinical parameters that can predict whether a patient can get significant improvement at the 10th week,or whether a patient can have an extended length of remission after discontinuing the infusion in ankylosing spondylitis(AS)patients treated with three standard infusions of in- fliximab.Methods Sixty-three AS patients were given three infusions of 5 mg/kg of infliximab at week 0,2 and 6;and were evaluated serially before each infusion and week 10.Afterwards.patients were followed by telephone interview until their disease activity was≥60% of the baseline level.At that point,disease was con- sidered to relapse.Clinical parameters at baseline as well as at week 2 were used to identify factors which might predict an improvement at week 10,or predict a delayed relapse.A predictor was regarded as being use- ful if the area under the curve(AUC)more than 0.75 when analyzed by receiver operator calculations(ROC). Results No parameters at baseline have sufficient predictive value.However,ASAS20(Assessment in Anky- losing Spondylitis International working Group criteria)at week 2 predicts improvement at week 10.and also duration of remission after discontinuing the infliximab at week 6.Conclusion The response to one pulse of infliximab is the best predictor of subsequent response as well as rate of relapse after discontinuing the inflix- imab.

Etiological factors and clinical characteristics of thirteen cases of non-traumatic rhabdomyolysis / 中华风湿病学杂志

Objective To investigate the etiological factors, clinical features and prognosis of non- traumatic rhabdomyolysis(RML). Methods The medical records of 13 non-traumatic RML patients hospital- ized between 1995-2006 were reviewed. The etiological, clinical, laboratory and therapeutic data were anal- ysed. Results Among 13 patients with non-traumatic RML, multiple factors were responsible for rhabdomyol- ysis in eight patients and single etiologic factor in 5 patients. Different etiological factors were identified, in- cluding 6 with excessive exercise, 3 with hyperpyrexia, 3 with drugs(including illicit drugs, fenofibrate, cy- closporine), 3 complicated with inflammatory myopathy and 2 with limbs compression. Nine patients had myal- gia and muscle weakness, 6 patients had abnormality in nervous system, 4 patients had hyperpyrexia, 3 pa- tients had digestive symptoms. Nine patients were complicated by coagulation disorders and 6 with acute renal failure(ARF). The serum levels of creatine kinase(CK)were decreased to normal within one month in 6 patients, the patient whose rhabdomyolysis was induced by fenofibrate with diabetes and chronic renal failure showed to inadequate decrease within 60 days. Three patients whose problem was induced by inflammatory myopathy, CK levels decreased within 4 months and 6 months in 2 patients, respectively, but CK level was not returned to normal level in one patient during the 80 follow-up days. Three patients died from multiple causes, such as ARF, coagulation disorders,electrolyte and metabolic disturbances. Conclusion Excessive exercise is the most common cause of non-traumatic RML, followed by drugs and inflammatory myopathy. The prognosis is poor in patients with multiple etiological factors and ARF.