Osteoporosis in patients with ankylosing spondylitis / 中国实用内科杂志

Objectives To study the frequency and risk factors of osteoporosis,and the relationship between bone turnover makers and bone mineral density (BMD) in patients with ankylosing spondylitis (AS).Methods BMD in the spine and femoral neck was measured with dual-energy x-ray absorptiometry (DEXA) in 30 AS patients. Enzyme linked immunoassay was used to measure serum bone gla protein (BGP), bone-specific alkalin phosphtase (BAP), and urine deoxypyridinoline crosslinks (D Pyr).Results The patients in early stage lost the bone mass already.They had lower volume of BMD in both hip and spines than that of controls. But in the later stage,the BMD of spines was higher than that of the control group because of the calcification of the surrounding tissues of the spine.While even the BMD of femoral neck was still lower than that of normal subjects. Osteoporosis was observed in 6 patients, osteopenia in 10. Osteoporosis in AS correlated negatively with the disease duration, ESR, CRP, and X ray grades. The reduction in BMD in premenopausal women with early AS was slighter than that in men. The BMD had no significant differences in HLA B 27 (+) patients and HLA B 27 (-)patients. BGP and BAP which reflect bone formation had no differences in AS patients and controls. D Pyr which reflects bone resorption was significantly increased compared with controls.Conclusions Osteoporosis in AS is common and may be related to disease duration and severity. A significant increase in bone resorption is observed in AS with osteoporosis.

The study of hidden rheumatoid factor detection and its clinical significance / 中华风湿病学杂志

0.05). HRF couldn′t be detected in 28 ankylosing spondylitis patients. The correlation was found between the serum levels of HRF and CRP in active RA patients (r=0.331,P

Leflunomide, a new disease-modifying drug for treating active rheumatoid arthritis in methotrexate-controlled phase II clinical trial / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of leflunomide in comparison with methotrexate (MTX) on patients with rheumatoid arthritis (RA) in China.</p><p><b>METHODS</b>Five hundred and sixty-six patients with active rheumatoid arthritis were randomly assigned to receive leflunomide at 20 mg once daily or MTX at 15 mg once weekly in a controlled trial. Five hundred and four patients completed the 12-week treatment and some patients continued the treatment for 24 weeks.</p><p><b>RESULTS</b>Both leflunomide and MTX could improve the symptoms, signs, and joint function, but there were no changes in X-ray observations of patients with rheumatoid arthritis. In the leflunomide group, the overall rates of effectiveness at 12 weeks and 24 weeks were 86.94% and 92.31% respectively; the rates of remarkable improvement were 64.95% and 79.81% respectively. In the MTX group, the overall rates of effectiveness at 12 weeks and 24 weeks were 84.04% and 83.15% respectively; the rates of remarkable improvement were 56.81% and 75.28% respectively. According to intent-to-treat analysis, the ACR 20% response rates at 12 weeks and 24 weeks in the leflunomide group were 62.54% and 67.18% respectively, compared with 60.08% and 61.32% respectively in MTX group. No statistical differences were shown in the efficacy between the two groups (P > 0.05). The adverse events in the leflunomide group were gastrointestinal symptoms, skin rash, alopecia, nervous system symptoms, decreased leukocyte count, and elevation of alanine aminotransferase (ALT). Most of these side effects were mild and transient. The incidence of adverse events in the leflunomide group was 16.84%, significantly lower than that in MTX group (28.17%, P = 0.002).</p><p><b>CONCLUSIONS</b>Leflunomide is effective in the treatment of RA with less adverse events than MTX. Its efficacy is similar to MTX, but the incidence of adverse events and the rate of withdrawal due to adverse events were lower in the leflunomide group than in MTX group.</p>

Clinical pathology of autoimmune cholangitis / 中华风湿病学杂志

Objective To investigate clinical and pathological features of autoimmune cholangitis (AIC) in antimitochondrial antibody (AMA) positive and negative patients.Method According to AMA presence or absence,37 primary biliary cirrhosis (PBC) patients were assigned to AMA positive group and AIC group.Clinical and pathological differences between two groups were compared.Results No differences were found in the level of liver function,liver cirrhosis,frequency of cholestasis and bile duct lesions between two groups.However,lower serum level of alkaline phosphatase,severer hepatocellular damage in pathology and higher AIH score were found in AIC group.Therefore the frequency accompanied by Sjgren′s syndrome (SS) in AIC group was significant higher.Conclusion AIC group is companied by slighter cholestasis and severer damage of hepatocytes indicating more autoimmune findings of AIC patients.AIC may have some correlation with SS in etiology and pathogenesis.

Thinkings of Making a Good job of Medical Ethics Teaching in new Situation / 中国医学伦理学

The continuous development of socialism market economy brings about a new opportunity and a challenge to the medical ethics teaching of college or Universities. How to do the teaching well, to guide students to building up correct medical moral thought. The author thinks that catching up the times strengthening aim at teaching, raising substantial results are the problem which should be paid attention to in current teaching program.